This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cohn, K. Articles by Goldschlager, N. Search for Related Content PubMed PubMed Citation Articles by Cohn, K. Articles by Goldschlager, N.

Circulation, Vol 59, 286-296, Copyright © 1979 by American Heart Association

ARTICLES

Use of treadmill score to quantify ischemic response and predict extent of coronary disease

K Cohn, B Kamm, N Feteih, R Brand and N Goldschlager

In this study we assessed whether various responses to exercise testing could be quantified in order to derive the probabilities of presence of coronary disease, and if present, to assess its severity. A treadmill score based on the exercise response was determined in 405 patients who had both treadmill tests and coronary angiograms. The score was derived using discriminant function analysis, by weighting and combining depth and configuration of ST depression (downsloping, horizontal or slowly upsloping), timing onset and duration of ischemia, grading ventricular arrhythmias, heart rate and blood pressure change, coexistence of exercise-induced chest pain and sex. The treadmill score was effective in detecting coronary disease (lesions with an greater than or equal to 50% narrowing), with a predictive accuracy (PA) (probability that a subject manifesting a positive test has disease) of 87%, a true negative rate (TNR) (probability of a subject with a negative test having no disease) of 80%, and sensitivity of 94%. The treadmill score also detected severe disease (triple-vessel, main left and/or greater than 90% proximal occlusion of the left anterior descending artery), with a PA of 73%, TNR of 79% and sensitivity of 82%. We conclude that the exercise response, expressed numerically as a treadmill score, permits analysis of most of the relevant data from exercise testing, increases test accuracy by 10-15% compared with standard criteria for treatmill test interpretation, and enables the derivation of probability statements for presence and severity of coronary disease. The validity of any prediction on the basis of exercise performance may thus be quantitatively judged.

This article has been cited by other articles:

				J. M. F. Kwok, T. D. Miller, D. O. Hodge, and R. J. Gibbons Prognostic value of the Duke treadmill score in the elderly J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1475 - 1481. [Abstract] [Full Text] [PDF]

				V. Raxwal, K. Shetler, A. Morise, D. Do, J. Myers, J. E. Atwood, and V. F. Froelicher Simple Treadmill Score To Diagnose Coronary Disease Chest, June 1, 2001; 119(6): 1933 - 1940. [Abstract] [Full Text] [PDF]

				C. A. Thompson, S. Jabbour, R. J. Goldberg, R. Y. S. McClean, B. Z. Bilchik, C. M. Blatt, S. Ravid, and T. B. Graboys Exercise performance-based outcomes of medically treated patients with coronary artery disease and profound ST segment depression J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2140 - 2145. [Abstract] [Full Text] [PDF]

				J. M. F. Kwok, T. D. Miller, T. F. Christian, D. O. Hodge, and R. J. Gibbons Prognostic Value of a Treadmill Exercise Score in Symptomatic Patients With Nonspecific ST-T Abnormalities on Resting ECG JAMA, September 15, 1999; 282(11): 1047 - 1053. [Abstract] [Full Text] [PDF]

				B. De Bruyne, J. Bartunek, S. U. Sys, and G. R. Heyndrickx Relation Between Myocardial Fractional Flow Reserve Calculated From Coronary Pressure Measurements and Exercise-Induced Myocardial Ischemia Circulation, July 1, 1995; 92(1): 39 - 46. [Abstract] [Full Text]