The application of electrocardiographic screening and exercise testing to preventive cardiology

Abstract

The resting electrocardiogram and the electrocardiographic response to exercise testing are methods of screening for silent coronary artery disease. This paper presents a review of the studies reporting findings using these methods in screening asymptomatic populations. The use of serial resting electrocardiograms has a definite but limited value in preventive cardiology. Exercise testing has a greater yield of abnormals, and the data regarding its specificity and sensitivity are discussed. Highly significant risk ratios have been demonstrated, and exercise testing can be a valuable screening tool yielding information additional to the primary risk factors. Abnormal responders have a substantial risk of having silent coronary artery disease and should be advised to eliminate their controllable risk factors for coronary heart disease. However, an abnormal electrocardiographic response to an exercise test does not absolutely indicate that an individual has silent coronary artery disease or a grave prognosis. It appears that the abnormal electrocardiographic response to exercise tests using low levels of stress is more specific for coronary artery disease than the abnormal response to higher levels of exercise. However, exercise tests using maximal or near-maximal exercise are more sensitive. Epidemiological studies with longer periods of follow-up are required to clarify the sensitivity and specificity of maximal or near-maximal exercise screening tests for predicting the risk of the development of coronary heart disease.