Value Of Exercise Electrocardiography Research Articles

The Value of Exercise Electrocardiography in Outpatients with Stable Chest Pain and Low Pre-Test Probability of Significant Coronary Artery Disease.

The role of exercise electrocardiography (ECG) in the investigation of stable chest pain has been questioned. The American Heart Association guidelines suggest the use of exercise ECG in patients with stable chest pain and low pre-test probability (PTP) of significant coronary artery disease, while the European Society of Cardiology Guidelines does not. This retrospective observational study aimed to assess the usefulness of exercise ECG in the low-PTP population with stable chest pain. We reviewed the medical records for all outpatient exercise ECGs conducted because of stable chest pain at the Department of Medicine and Emergency, Sahlgrenska University Hospital, Mölndal, Sweden, during 2016-2018. The identified patients were categorized in low-, intermediate-, or high-risk pre-test probability of significant coronary artery disease. All low-PTP patients were followed for one year post investigation for the incidence of acute coronary syndrome and all-cause mortality. Thus, 505 patients (mean age 60 years, 56% women) with low PTP were included in the study. Only four patients (0.6%) experienced incident myocardial infarction (three patients) or all-cause mortality (one patient). The negative predictive value of exercise ECG was 99.7%, and the positive predictive value was 28.6%. In this low-PTP population, exercise ECG yields a good negative predictive value and a poor positive predictive value.

Preoperative Stress Testing before Non-Cardiac Surgery.

The current guidelines from various medical societies provide a good summary of data regarding various preoperative exercise tests in patients prior to non-cardiac surgical interventions. However, there is no consensus among experts on the appropriateness of these methods for identifying risk groups for potential perioperative complications. A large volume of published studies describes the role of preoperative exercise stress testing impact in improving the prediction of potential cardiovascular (CV) risk in patients after non-cardiac surgery. Numerous stress tests are available in clinical practice, and the methods used and the best choice depends on the purpose of the study and the availability of equipment in the hospital. Traditionally, the value of exercise electrocardiography (ECG), or ECG stress test, has been based on the belief that it is beneficial for perioperative cardiac risk prediction. However, in the past two decades, the key role of this method has lost its importance due to the growing trend toward the use of imaging techniques. Moreover, in light of current trends, the six-minute walk test (6MWT) is a helpful tool in preoperative assessment and plays an important role in postoperative rehabilitation. Interestingly, the recent finding showed how 6MWT affects the risk of postoperative complications. Cardiopulmonary testing, as a dynamic clinical tool, determines the cardiorespiratory status of a patient. Various clinical indications for cardiopulmonary exercise testing include evaluation of therapy, stratification of risk factors, diagnosis of disease, and control of physical activity. Stress testing is one of the most practical ways of predicting perioperative risk and managing patients. This test is based on ischemia provoked by pharmacological agents or exercise. There is no established evidence of a significant advantage of pharmacological stress over exercise stress imaging in subjects who are capable enough to be physically active. All of these studies examined a stress test for induced myocardial ischemia. Currently, there are no data on the use of ischaemic stress tests, especially diastolic stress tests, in the assessment of perioperative risk before non-cardiac surgical interventions. We consider it promising and essential to continue research in this direction in patients with coronary heart disease and other categories of cardiac patients, in particular, comorbid and low-symptomatic individuals, before elective high-risk surgical interventions.

Comparison of exercise electrocardiography and magnetocardiography for detection of coronary artery disease using ST-segment fluctuation score.

Exercise electrocardiography (ECG) is frequently used as a diagnostic measure in patients with suspected coronary artery disease (CAD). However, it has low sensitivity for the detection of CAD. Magnetocardiography (MCG) has been proposed as an alternative tool to accurately diagnose CAD. To date, a direct comparison of MCG to ECG has not been performed. This study sought to compare them for predicting the presence of significantly obstructive CAD. The patients with chest pain or other symptoms suggestive of CAD were enrolled in the analysis. All the patients underwent a clinical evaluation, exercise ECG, MCG test, and coronary angiography (CA). CAD was defined as stenosis ≥70% in at least one major coronary artery on quantitative analysis of CA. We prospectively enrolled 202 consecutive patients who suggested CAD. The prevalence of CAD on CA was 39.1%. Sensitivity and accuracy for CAD diagnosis was higher for MCG compared with exercise ECG (sensitivities 68.4% and 40.5%, p <0.001, specificities 95.1% and 91.1%, p = 0.267, and accuracies 84.7% and 71.3%, p <0.001, respectively). There was no incremental diagnostic value of combined MCG and ECG to detect coronary artery disease (p = 0.357). For the patients with intermediate to high risk of CAD, MCG exercise test provides better diagnostic accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.

Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review.

Although test characteristics of exercise electrocardiography are well established in symptomatic patients, data on healthy athletes are scarce. This systematic review focuses on the diagnostic utility of exercise electrocardiography for the detection of coronary heart disease in athletes during pre-participation screening. This systematic review evaluated the prevalence of an abnormal exercise test result and the positive predictive value of exercise electrocardiography in asymptomatic athletes. In addition, the long-term prognosis of a false-positive test result was evaluated. An electronic search was performed using the Cochrane Library, PubMed, and MEDLINE. Only studies using exercise electrocardiography in an unselected population of asymptomatic athletes were included. Data on population characteristics, cardiovascular risk factors, exercise test parameters, left ventricular hypertrophy, and morbidity/mortality were extracted and analyzed. The mean prevalence of an abnormal exercise test result was 0.6% (range 0-29%), with a positive predictive value of 9% (range 0-55%). Left ventricular hypertrophy was observed in 57% of the athletes with an abnormal exercise test result, in 50 % of the athletes with a false-positive exercise test result, and in 24% of the athletes with a normal exercise test. Among athletes with a false-positive test, only one athlete (3%) experienced a possible cardiac event. This systematic review revealed a relatively low prevalence of positive exercise test results in asymptomatic athletes, but a very poor positive predictive value. There were insufficient data available to determine the prognostic implications of false-positive test results in asymptomatic athletes.

Positive Predictive Value of Exercise Electrocardiography in Patients Referred from a Brisbane Emergency Department with Chest Pain

Positive Predictive Value of Exercise Electrocardiography in Patients Referred from a Brisbane Emergency Department with Chest Pain

Coronary computed tomographic angiography and exercise electrocardiography: a great match or unequal partners?The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Coronary computed tomographic angiography (CCTA) is emerging as a powerful non-invasive tool in the diagnosis of coronary artery disease (CAD). However, there is concern that CCTA is being used indiscriminately without sufficient examination of its added value vis-a-vis more established forms of non-invasive testing.1 With an ever-growing armament of non-invasive tests for the diagnosis and evaluation of CAD, cardiologists must consider the following questions in weighing up the implementation of a new diagnostic modality in the routine clinical setting. Is testing necessary for the diagnosis of CAD in a particular patient group? Will testing guide management decisions and identify patients who may benefit from coronary revascularization? Will the benefits of testing outweigh its potential risks? The study by Mollet et al. 2 provides important insights into the relationship between the findings of CCTA and conventional treadmill exercise electrocardiography (ECG), but also raises important issues regarding the role of both tests in the diagnosis of CAD. The authors examined, in 62 patients with typical angina pectoris, the diagnostic value of exercise ECG and 16-slice multidetector CCTA, alone and in combination, to predict ≥50% diameter stenoses detected on invasive, selective coronary angiography (SCA) in any coronary artery branch with a calibre of ≥2 mm. Exercise ECG data from 53 patients and CCTA data from 61 patients were included in the analyses. The sensitivity of exercise ECG was 78%, specificity was 67%, and positive and negative predictive values were 89 and 47%, respectively. The sensitivity of CCTA was 100%, specificity was 87%, and positive and negative predictive values were 96 and 100%, respectively. In an analysis based on Bayesian principles, an abnormal CCTA increased the post-test probability of significant CAD after a positive exercise ECG from 89 to 99% and after a negative exercise ECG from 58 to 91%. A normal CCTA … *Corresponding author. E-mail address : gerber.thomas{at}mayo.edu

Is it possible to increase the diagnostic value of exercise electrocardiography by post-exercise B-type natriuretic peptide levels?

Objective — Exercise electrocardiography is commonly available and a cost-effective test and therefore is widely used for the diagnosis of coronary artery disease. However, false positivity remains an important problem resulting in many unnecessary coronary angiographic examinations. In this study, we aimed to test the hypothesis that post-exercise B-type natriuretic peptides secreted in response to transient myocardial ischaemia induced by exercise, add any further information on positive test results.Methods — Patients who underwent exercise electrocardiography with the suspicion of coronary artery disease were screened and those with positive test results based on standard electrocardiography criteria were selected. Blood samples for B-type natriuretic peptides were obtained within 5minutes after exercise test. Patients included in the study had preserved left ventricular function on echocardiography. At least 70% stenosis of one epicardial coronary artery on coronary angiography was diagnosed as significant coronary artery disease.Results — Of the 55patients (age 59.8 ± 7.6 y; 48men) included in the study 29 had (52.7%) coronary artery disease requiring revascularization (CAD+) and 26 (47.3%) did not have significant coronary artery disease (CAD-).The cardiovascular risk factor profile of CAD+ and CAD-patients were similar (all p>0.05).The median post-exercise B-type natriuretic peptide level was significantly higher in CAD+ (47.20 pg/ml) than CAD- patients (18.90 pg/ml) (P=0.001).The sensitivity and specificity of a post-exercise B-type natriuretic peptide level>30 pg/ml for the diagnosis of coronary artery disease in exercise test positive patients were calculated as 72% and 69%, respectively.Conclusion — The measurement of post-exercise B-type natriuretic peptide levels may increase the diagnostic value of positive exercise electrocardiography.

Clinical, exercise electrocardiographic, and pharmacologic stress echocardiographic findings for risk stratification of hypertensive patients with chest pain

Exercise electrocardiography (ECG) is of limited usefulness in hypertensive patients, whereas pharmacologic stress echocardiography can provide diagnostic and prognostic information. The aim of this study was to compare the prognostic value of clinical data, exercise ECG, and pharmacologic stress echocardiography in hypertensive patients with chest pain and to identify the best strategy for their risk stratification. Three hundred sixty-seven hypertensive patients (189 men, age 61 ± 9 years) with chest pain of unknown origin underwent exercise ECG and pharmacologic stress echocardiography (237 with dipyridamole and 130 with dobutamine) and were followed up for 31 ± 24 months. Positive exercise ECG (ST-segment shift of ≥1 mm at 80 ms after the J point) and stress echocardiography (new wall motion abnormalities) were found in 130 (35%) and 86 (23%) patients, respectively. During follow-up, there were 13 deaths and 16 myocardial infarctions. Additionally, 43 patients underwent coronary revascularization and were censored accordingly. Of 12 clinical, electrocardiographic, and echocardiographic variables analyzed, a positive result of stress echocardiography was the only multivariate predictor of either death (hazard ratio [HR] 4.7, 95% confidence interval [CI] 1.5 to 14.5, p = 0.007) or hard events (death, myocardial infarction) (HR 4.1, 95% CI 1.8 to 9.3, p = 0.0009). Using an interactive stepwise procedure, stress echocardiography provided additional prognostic information to clinical evaluation and exercise ECG. However, the negative predictive value of the 2 tests was similarly (p = NS) high in assessing 4-year event-free survival. In conclusion, a negative exercise electrocardiographic test identifies low-risk hypertensive patients with chest pain and should be the first-line approach for risk stratification. In contrast, positive exercise ECG is unable to distinguish between patients with different levels of risk. In this case, stress echocardiography provides strong and incremental prognostic power over clinical and exercise electrocardiographic data.

The value of exercise electrocardiography in women with chest pain: comparison with exercise echocardiography

The value of exercise electrocardiography in women with chest pain: comparison with exercise echocardiography

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects

The aim of the study was to compare the efficacy and safety of two stress echocardiography methods, exercise and dobutamine, in the diagnosis of coronary artery disease in hypertensive patients with angina. A total of 197 treated hypertensive patients, age 53 +/- 9 years (65 women) with no history of myocardial infarction referred for coronary angiography were prospectively investigated with exercise electrocardiography (ECG), exercise and dobutamine echocardiography. Sensitivity of the exercise ECG, exercise echocardiography and dobutamine echocardiography did not differ (77%, 82% and 75%). Negative predictive value of exercise ECG was significantly lower than exercise echocardiography (64% vs 79%, P < 0.01). Specificity and positive predictive value of exercise ECG were markedly lower than exercise and dobutamine echocardiography (57%, 96%, 98% and 72%, 97%, 98%, P < 0.0001 for both stress echocardiography vs ECG). Specificity and sensitivity of diagnostic methods were not influenced by the presence of echocardiographic left ventricular hypertrophy. Dobutamine infusion in comparison to exercise was more often associated with substantial arterial blood pressure rise or fall (7% vs 2%, P < 0.05) and with simple ventricular ectopy (15,7% vs 6,1%, P < 0.05). In hypertensive patients with the symptoms of angina, both stress echo methods are significantly more specific than the exercise ECG test. Maximal exercise is associated with less frequent side effects than infusion of dobutamine, so exercise echocardiography may be preferred in the diagnosis of angina in hypertensive patients.

Detection of coronary restenosis by exercise electrocardiography thallium-201 perfusion imaging and coronary angiography in asymptomatic patients after percutaneous transluminal coronary angioplasty

Noninvasive detection of restenosis in patients remaining asymptomatic after percutaneous transluminal coronary angioplasty (PTCA) remains a major clinical problem. The value of exercise electrocardiography (ECG) and exercise-redistribution thallium-201 single-photon emission computed tomography (SPECT) in detecting restenosis in such patients remains uncertain. Discordances between these tests and coronary angiography is a common situation. We studied 179 consecutive patients remaining asymptomatic after successful PTCA (208 vessels), who underwent 6 ± 2 months of exercise ECG, SPECT, and coronary angiography. We sought to assess the diagnostic value of the noninvasive tests compared with coronary angiography, and identify the determinants of discordances between the tests. Restenosis (diameter stenosis >50%) was detected in 39% of patients and in 37% of vessels. The overall sensitivity, specificity, and accuracy for exercise ECG and SPECT in detecting restenosis in individual vessels were, respectively, 53% versus 63% (p = 0.06), 59% versus 77% (p = 0.0001), and 57% versus 72% (p = 0.0001). On multivariate analysis, positive exercise ECG was associated with higher heart rate response (p = 0.02), incomplete revascularization (p = 0.004), and angiographic restenosis (p = 0.03), whereas positive SPECT was associated with incomplete revascularization (p = 0.02), infarct-related artery PTCA (p = 0.01), and angiographic restenosis (p = 0.0001). Accuracies of the 2 tests were not significantly different in patients with incomplete revascularization or PTCA of an infarct-related vessel. Overall, SPECT is more accurate than exercise ECG in detecting asymptomatic restenosis. Nevertheless, incomplete revascularization and PTCA of an infarct-related artery could cause reversible perfusion defects regardless of restenosis, reducing the diagnostic value of SPECT in such patients.

Comparison of major complication rates associated with four methods of arterial closure

1. Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, McArthur D, Froelicher V. Exercise-induced ST depression in the diagnosis of coronary artery disease: a meta analysis. Circulation 1989;80:87–98. 2. Okin P, Kligfield P. Heart rate adjustment of ST segment depression and performance of the exercise electrocardiogram: a critical evaluation. J Am Coll Cardiol 1995;25:1726–1735. 3. Kligfield P, Ameisen O, Okin P. Relation of the exercise ST/HR slope to simple heart rate adjustment of ST segment depression. J Electrocardiol 1987; 20(suppl):135–140. 4. Kligfield P, Ameisen O, Okin PM. Heart rate adjustment of ST segment depression for improved detection of coronary artery disease. Circulation 1989; 79:245–255. 5. Kligfield P, Okin PM. Heart rate adjustment of ST segment depression: is the glass half empty or half full? J Am Coll Cardiol 1992;19:19–20. 6. Detrano R, Salcedo E, Passalacqua M, Friis R. Exercise electrocardiographic variables. A critical appraisal. J Am Coll Cardiol 1986;8:836–847. 7. Lachtermann B, Lehmann K, Detrano R, Neutel J, Froelicher V. Comparison of ST segment/heart rate index to standard ST criteria for analysis of exercise electrocardiogram. Circulation 1990;82:44–50. 8. Quyyumi AA, Raphael MJ, Wright C, Bealing L, Fox KM. Inability of the ST segment/heart rate slope to predict accurately the severity of coronary artery disease. Br Heart J 1984;51:395–398. 9. Balcon R, Brooks N, Layton C. Correlation of heart rate/ST slope and coronary angiographic findings. Br Heart J 1984;52:304–307. 10. Ellestad MH, Crump R, Surber M. The significance of lead strength on ST change during treadmill stress test. J Electrocardiol 1992;25:31–34. 11. Ellestad MH. Stress Testing: Principles and Practice, 4 ed. Philadelphia: FA Davis, 1996:245–259. 12. Malekinapour M, Rodes J, Cote G. Juneau M, Bonan R, Lesperance J, Couturier A, Tardiff JC. Value of exercise electrocardiography in the detection of restenosis after coronary angioplasty in patients with one-vessel disease. Am J Cardiol 1999;84:258–263.

Value of exercise electrocardiography in the detection of restenosis after coronary angioplasty in patients with one-vessel disease

Exercise treadmill testing (ETT) is considered an unreliable method for detection of restenosis after percutaneous transluminal coronary angioplasty (PTCA). The studies on which this belief is based have used quantitative coronary angiography (QCA) as a reference. The inherent limitations of angiography have been demonstrated by intravascular ultrasound (IVUS). To determine the value of ETT for detecting restenosis when IVUS criteria are used to define restenosis, we studied 29 patients with angiographically documented 1-vessel coronary disease (<35% stenosis in all nondilated segments) who underwent angioplasty. ETT was performed ≤2 weeks before follow-up angiography and IVUS imaging. Only patients without any abnormalities precluding an accurate reading of the ST segment during ETT were included. Restenosis was defined as a ≥50% diameter stenosis by QCA criteria and as a cross-sectional area narrowing of ≥75% by IVUS. The ETT was positive in 12 patients and restenosis was documented by QCA and IVUS in 38% and 48% of cases, respectively. Sensitivity, specificity, and positive and negative predictive values of ETT when QCA was used as a reference were 55%, 67%, 50%, and 71%, respectively. This corresponded to an accuracy of 62% when compared with QCA. Sensitivity, specificity, and positive and negative predictive values were 79%, 93%, 92%, and 82% when ETT was compared with IVUS, with an accuracy of 86% (p = 0.002). Thus, ETT is a reliable noninvasive method for detecting the presence of restenosis after PTCA in patients with 1-vessel coronary artery disease. The presence of ≥75% cross-sectional narrowing shown by IVUS is well correlated with ≥1-mm ST-segment depression at follow-up ETT after PTCA.

Coronary artery disease in women

EDITOR,—Graham Jackson addresses the value of exercise electrocardiography in the diagnosis of coronary artery disease in women.1 He points out that the false positive rate is higher in women aged under 65 than in those aged 65 and over. This is true if a single cut off point of 1 mm of ST segment depression …

What is the predictive value of exercise electrocardiography in the investigation of male aircrew aged 40-60 years old?

What is the predictive value of exercise electrocardiography in the investigation of male aircrew aged 40-60 years old?

Early exercise thallium‐201 single photon emission computed tomography in unstable angina: a prospective study

To evaluate the safety and diagnostic value of early symptom-limited exercise electrocardiography (ECG) and exercise thallium-201 single photon emission computed tomography (SPECT) in unstable angina (UA), 39 patients were studied prospectively soon after stabilization on medical treatment. No patient had a history of myocardial infarction (MI) or revascularization and patients with left bundle branch block were excluded. Exercise ECG and exercise thallium-201 SPECT were performed 8 +/- 4 days and 11 +/- 6 days respectively after admission to hospital. Seventeen out of 39 patients (44%) had positive exercise ECGs and 22 (56%) negative or inconclusive ones. Exercise thallium-201 SPECT was positive in 26 patients (67%) and negative in 13 patients (33%). Thirty-one patients underwent coronary arteriography and 24 of them proved to have significant coronary artery disease (CAD). The sensitivity, specificity and positive predictive value of exercise ECG in detecting CAD are 62%, 86%, and 94% respectively while the corresponding results are 96%, 100%, and 100% for exercise thallium-201 SPECT. Therefore, it is concluded that the early symptom-limited exercise test is safe in medically stabilized patients with UA. Early exercise thallium-201 SPECT is highly sensitive and predictive of the presence of significant CAD among patients in the early recovery phase of UA and can be used in selecting this group of patients for coronary angiography and other therapeutic strategies.

Silent ischemia after coronary angioplasty: Evaluation of restenosis and extent of ischemia in asymptomatic patients by tomographic thallium-201 exercise imaging and comparison with symptomatic patients

One hundred sixteen patients were evaluated to determine the ability of single photon emission computed tomographic (SPECT) thallium-201 exercise and redistribution imaging to detect silent ischemia secondary to restenosis in asymptomatic patients after single and multiple vessel percutaneous transluminal coronary angioplasty and the findings were compared with SPECT imaging detection of restenosis in symptomatic patients. The value of exercise electrocardiography (ECG) and the amount of ischemic myocardium in symptomatic and asymptomatic patients were determined. Forty-one patients were asymptomatic after angioplasty; 77% of these had chest pain before angioplasty. Seventy-five patients had chest pain after angioplasty; 99% of these had chest pain before angioplasty. Restenosis occurred in 61% of asymptomatic and 59% of symptomatic patients and in 46% of the vessels in both asymptomatic and symptomatic patients. Sensitivity, specificity and accuracy for detection of restenosis by SPECT in individual patients were 96%, 75% and 88% versus 91%, 77% and 85%, respectively, in the asymptomatic versus symptomatic groups (p = NS). Sensitivity, specificity and accuracy for restenosis detection in individual vessels were 90%, 89% and 89% versus 84%, 77% and 84%, respectively, in the asymptomatic and symptomatic groups (p = NS), with similar results for the three major arteries. Sensitivity and accuracy of exercise ECG were significantly less than those of SPECT imaging for the patients with silent (40% and 44%) and symptomatic (59% and 64%) ischemia (p less than 0.001). Restenosis of vessels in the patients with silent and symptomatic ischemia was associated with an equal amount and degree of severity of ischemic myocardium in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Variations and value of exercise electrocardiography

Variations and value of exercise electrocardiography

Relative value of exercise electrocardiography, long-term electrocardiographic monitoring and programmed electrical stimulation of the heart in the treatment of cardiac arrhythmias.

A long time ago, Sénac (1683-1770) treated palpitations with quinine. Three centuries later Wenckebach rediscovered the value of quinine in atrial fibrillation and now gets the credit for it, at least in the American literature. Life has plenty of paradoxes; the history of the treatment of arrhythmias too. Pope Clement XI (1649-1721) has become known in history for his opposition to adapting Catholic rituals to Chinese habits. He will never be credited as the man, however, who supported the first 'epidemiological' study on sudden death. It was 1705 when he ordered Lancisi to study by autopsy the cause of any unexpected death among Roman nobles. The results were rather disappointing. We have come a long way since then. While good clinical judgement and common sense remain the most important tools in the treatment of cardiac arrhythmias, technicological progress has provided us with refined techniques for studying that problem. Among them, long-term electrocardiographic monitoring, exercise testing and programmed electrical stimulation of the heart. However, and as Zipes pointed out, we are far from perfection in the treatment of cardiac arrhythmias. Whether it was Sénac or Wenckebach who first observed that quinine could change an irregular heart rhythm (atrial fibrillation) into a regular one (sinus rhythm), we are not far from their empiricism. However refined they may look, our present methods of diagnosis and treatment of arrhythmias are regrettably imperfect. These techniques have to be used carefully and rationally. Their present value and limitations will be outlined here.

Value of exercise electrocardiography to predict additional jeopardized myocardial regions remote from site of previous myocardial infarction.

In order to evaluate the efficacy of exercise electrocardiography (ECG) to identify jeopardized myocardial regions remote from the site of previous infarction, exercise ECG, left ventriculography, and coronary arteriography were performed in 90 patients with previous transmural myocardial infarction (MI). Of the 90 patients, angiographic studies revealed jeopardized myocardial regions in 47 patients. Exercise ECG correctly identified 32 of these 47 patients for a sensitivity value of 68%. There were 43 patients without any additional jeopardized myocardial regions. Exercise ECG correctly identified only 24 of these 43 patients for a specificity value of 56%. The sensitivity and specificity values were similar in patients with prior anterior and inferior wall MI. It is concluded that relatively low sensitivity and specificity values preclude the ability of exercise ECG to accurately identify patients with jeopardized myocardial regions distant from the site of previous MI. Moreover, when such patients were correctly detected, exercise ECG was rather poor in localizing these additional jeopardized myocardial areas.