Diagnostic and prognostic implications of exercise testing in coronary artery disease

The clinical indications for exercise testing as a diagnostic and prognostic tool in the assessment of patients with ischemic heart disease have gradually evolved since Master introduced the two-step exercise test in 1929 (1). New information from correlations between electrocardiographic and angiocardiographic data, the use of exercise test results for prognostic stratification in patient subsets and the role of other non-invasive methods which supplement the information obtained from exercise testing have markedly enhanced the clinical utility of the test. Exercise testing is currently most useful in the evaluation of patients in whom the origin of their chest pain must be elucidated, in patients with ischemic heart disease in whom the prognosis is to be assessed and in patients in whom the efficacy of antianginal therapy or revascularization procedures is to be measured. Although some physicians have become disillusioned with the diagnostic accuracy of the exercise test, the procedure remains an important, as well as relatively inexpensive technique in the routine assessment of patients with suspected or documented chronic heart disease of various causes. Since the main application of exercise testing is in patients with ischemic heart disease, this review of the status of the exercise test and the interpretation of exercise test results will be restricted to this patient group.