SeminarExercise testing in clinical medicine
Section snippets
Diagnosis
Meta-analysis of trials has shown that the exercise test has a specificity of around 80% and a sensitivity of around 70% for obstructive coronary disease confirmed by angiography.4 However, many of these studies had methodological problems of limited challenge and work-up bias. The former takes place when patients already known to have coronary artery disease (eg, those with previous myocardial infarction) are used to challenge a diagnostic test. Work-up bias describes the situation in which
Prognosis and novel indications
The overriding paradigm in the diagnosis of cardiovascular disease over the past decades has been the presumptive identification of obstructive coronary disease in order to direct interventional angiography or bypass surgery. However, shortcomings in non-invasive tests such as the work-up bias mentioned above, combined with limitations fundamental to angiography16 have led some to suggest that the principal place for the exercise test is in the assessment of prognosis (table 2). The appropriate
Protocol
Experience and history show that the pervasiveness of an idea, method, or product relies only in part on its intrinsic quality. Rather more, the acceptance of an idea relies on its extrinsic survival potential, a complex attribute with temporal, logistical, and experiential dimensions.39 In applied exercise testing, these features are apparent in relation to the choice of treadmill protocol. When treadmill and cycle ergometer testing was first introduced into clinical practice, practitioners
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