Uses and Limitations of Stress Testing in the Evaluation of Ischemic Heart Disease

Abstract

The results of stress testing in patients being assessed for coronary artery disease have led to conflicting claims and conclusions. It seems reasonably clear that stress testing is of considerable predictive value in epidemiologic studies; i.e., patients manifesting or developing a positive exercise test have a much higher probability of subsequently experiencing coronary events (angina pectoris, myocardial infarction, or coronary death) than those individuals with normal stress tests. Moreover, the risk seems to be related to the degree of S-T segment depression. In contrast, despite earlier claims regarding the diagnostic accuracy with which single-load stress tests could predict the presence or absence of ischemic heart disease in individual patients, studies correlating the results of testing with the degree and extent of angiographically demonstrated coronary artery disease have not consistently shown either acceptable sensitivity or specificity. Although on theoretic grounds it would be anticipated...