| Author, Year (Reference) |
Sample |
Exclusion Criteria |
Test |
Definition of Abnormal Exercise Electrocardiography Result |
Prevalence of Abnormal Exercise Tolerance Test Result |
Definition of Abnormal Cardiac Catheterization Result |
Abnormal Catheterizations/Total Catheterizationsb |
Abnormal Catheterizations/ Abnormal Exercise Tolerance Test Resultb |
Abnormal Exercise Tolerance Test Result and Abnormal Catheterizations/ All Screened Personsb |
Quality Grade |
| Caralis et al., 197927 |
3,496 men and women
Mean age: NR
% men NR |
NR |
Maximal exercise and thallium scintigraphy |
≥2 mm of horizontal ST-segment depression |
22/3496
(0.6%) |
NR |
10/15
(66.7%) |
10/22
(45.5%) |
10/3,496
(0.3%) |
Fair |
| Piepgrass et al., 198216 |
771 men in U.S. Air Force flight crew
Mean age ±SD, 42 ±5.2 y
100% men |
Resting electrocardio-graphic abnormalities, history of chest pain, cardiovascular disease, marked hypertension |
Maximal treadmill or two-step double Master's |
≥0.1 mV of ST-segment depression 80 ms from the J point or exercise induced arrhythmia |
27/771
(3.5%) |
NR |
4/19
(21%) |
4/27
(14.8%) |
4/771
(0.5%)
all cases were mild to moderate disease |
Fair |
| Hollenberg et al., 198538 |
377 U.S. Army officers
Mean age 37y
% men NR |
Known CHD |
Maximal treadmill - U.S. Air Force School Aerospace Medicine Protocol |
≥1 mm ST depression during or after exercise or treadmill exercise score <5 units |
45/377
(12%) |
≥50% narrowing of the luminal diameter of major epicardial artery |
1/10
(10%) |
1/45
(2%) |
1/377
(0.3%)
1 had 1- vessel disease |
Fair |
| Boyle et al., 198714 |
1,174 employees from 2 factories in the United Kingdom
Mean age: NR
Age range: 19-64y
95% men |
Symptoms of angina, orthopedic problems, hypertension with retinopathy, fainting, fibrillation |
Treadmill |
Maximal ST/heart rate slope value of >13
mm·beats-1 min 10-3 |
68/1,174
(5.8%) |
≥75% stenosis of epicardial artery |
9/24
(37.5%) |
9/68
(13.2%) |
9/1,174
(0.8%)
1 patient had coronary artery bypass graft surgery |
Fair |
| Okin et al.,198831 |
606 men in the Army Reserve at moderate to high risk by Framingham Risk score
Mean age: NR
Age: >40 years
100% male |
Known or suspected CHD or angina |
Modified Balke-Ware with radionuclide scintigram for an abnormal exercise ECG |
≥1 mm ST depression |
10/606 (1.7)
positive—abnormal exercise electro-cardiogram and scintigram;
52/606 (8.6)
inconclusive—abnormal exercise electrocard-iogram and normal scintigram) |
≥50% narrowing of the luminal diameter |
7/10
(70%) |
7/10
(70%) |
7/606
(1.2%)
2 patients had 3-vessel disease,
2 had 2-vessel disease,
3 had 1-vessel disease |
Good |
| Koistinen 199015;75 |
136 diabetic patients in Finland
Mean age: 49 y
62% men |
Clinical evidence of CHD, use of lipid lowering agents, diabetes mellitus for less than 5 y, retinopathy, renal failure |
Maximal bicycle ergometry and thallium scintigraphy |
≥1 mm horizontal or downsloping ST-segment depression |
40/136
(29%) |
Significant (≥50%) narrowing of the luminal diameter |
12/34
(35%) |
12/40
(30%) |
12/136
(9%)
2 patients had 3-vessel disease,
5-had 2-vessel disease,
5 had 1-vessel disease |
Fair |
| Dunn et al., 199130 |
1,930 patients referred to Cleveland Clinic Foundation for screening exercise tolerance testing in 1987-1988(5.6% had history of chest pain)
Mean age: 49 y
85% men |
Known CAD |
Symptom-limited exercise electrocardiography, then thallium scintography if results were abnormal |
≥1 mm of horizontal or downsloping ST-segment depression, or arrhythmia |
155/1,930
(8%) |
≥50% blockage of any major vessel |
25/41
(61%) |
25/155
(16.1%) |
25/1,930
(1.3%)
6 patients had coronary artery bypass graft surgery |
Fair |
| Massie et al., 199318 |
226 men from the San Francisco Veteran's Medical Center, all of whom had hypertension and at least 1 other cardiovascular risk factor
Mean age ± SD, 61 ± 8 y
100% men |
Known cardiac disease history or symptoms, resting electrocardio-graphy abnormalities, paced rhythm, noncardiac limitation to exercise |
Standard Bruce with thallium scintigraphy |
≥0.1 mV of additional horizontal or downsloping ST-segment depression at 80 ms after the J point |
Abnormal exercise electrocard-iogram 67/226 (30%)
Abnormal scintigram 41/226 (18%) |
Intraluminal lesion of =50% diameter of vessel in 2 projections |
14/26
(54%)
18/21
(86%) |
14/67
(21%)
18/29
(62%) |
20/226
(9%)
6 patients had left main disease or 3-vessel disease;
5 had 2-vessel disease;
7 had 1-vessel disease |
Fair |
| Davies et al., 199623 |
5,000 men from the United Kingdom
Mean age: NR
100% men |
NR |
Modified Balke |
1 mV of horizontal or downsloping depression persisting for ≥5 complexes |
162/5,000
(3.2%) |
≥75% stenosis epicardial artery |
67/86
(78%) |
67/162
(41.4%) |
67/5,000
(1.3%)
26 patients had coronary artery bypass graft surgery |
Fair |
| Cameron et al., 199725 |
229 Australians who responded to questionnaire about chest pain
Mean age: NR
43% men |
Known CAD or negative screening questionnaire |
Modified Bruce |
Flat ST- segment depression ≥0.15 mV |
Men
15/98 (15.3%)
women
17/131 (13%) |
NR |
10/13
(77%) |
10/32
(31%) |
10/229
(4%)
4 patients had coronary artery bypass graft surgery |
Fair |
| Pilote et al., 199828 |
4,334 patients referred to Cleveland Clinic Foundation for screening exercise tolerance testing in 1990-1993
Median age: 51 y
89% men |
History of chest pain, heart failure, valvular or congenital heart disease, arrhythmia or digitalis use |
Bruce or modified Bruce |
≥1 mm horizontal or downsloping ST-segment depression, ≥1 mm ST elevation in leads other than aVR or V1, decrease in blood pressure ≥10 mmHg, typical chest pain, failure to reach target heart rate |
633/4,334
(15%) |
Coronary artery disease ≥1 coronary segment with ≥50% stenosis |
71/126
(56%) |
71/633
(11%) |
71/4,334
(1.6%);
19 patients had left main disease or 3-vessel disease |
Fair |
| Livschitz et al., 200022 |
4,900 male soldiers in the Israeli army ≥39 years of age
Mean age ±SD 43 + -3 y
100% men |
Angina, heart failure, valvular disease, congenital heart disease, arrhythmia |
Bruce |
≥1 mV of horizontal or downsloping ST-segment depression or ≥1.5 mV upsloping ST-segment depression |
299/4,900
(6.1%) |
NR |
3/4
(75%) |
3/299
(1%) |
3/4900
(0.06%)
1 patient had coronary artery bypass graft surgery
2 had 1-vessel disease |
Good |
| Blumenthal et al., 200317 |
734 primarily white healthy siblings of persons with CAD diagnosed before age 60 in Baltimore
Mean age: NR
but <60 y
"Primarily male" |
Known CAD, limitations that precluded testing |
Modified Bruce and thallium scintigraphy |
NR for exercise tolerance testing |
153/734
(21%)
(Abnormal exercise electrocardio-gram, scan, or both) |
Clinically significant CAD: intraluminal lesion of ≥50% diameter |
41/105
(39%) |
41/153
(27%) |
41/734
(5.5%) |
Good |
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