Can computerization of the exercise test replace the
J. Edwin Atwood, MD
Dat Do, BA
Victor Froelicher, MD
Robert Chilton, MD
Charles Dennis, MD
Jeff Froning, MA
Andras Janosi, MD
David Mortara, PhD
Jonathan Myers, PhD
Palo Alto and Vista, Calif.; San Antonio, Texas; Milwaukee, Wis.;
Brown Mills, N.J.; and Budapest, Hungary
Background The type of practitioners who use the standard
exercise test is changing. Once a tool of the cardiologist, the standard exercise test is
now being performed by internists and other noncardiologists. Because this change could be
facilitated by computerization similar to the computerized interpretation programs
available for the resting electrocardiograph (ECG), we performed this analysis. A
secondary aim was to demonstrate the effects of medication status and resting ECG
abnormalities on test diagnostic characteristics because these factors affect utility of
the exercise test by the generalist.
Methods and Results A retrospective analysis was performed of consecutive patients
referred at 2 university-affiliated Veterans Affairs Medical Centers and a Hungarian
Hospital for evaluation of chest pain and possible ischemic heart disease. There were 1384
consecutive male patients without a prior myocardial infarction with complete data who had
exercise tests and coronary angiography between 1987 and 1997. Measurements included
clinical, exercise test data, and visual interpretation of the ECG recordings as well as
more than 100 computed measurements from the digitized ECG recordings and compilation of
angiographic data from clinical reports. The computer measurements had similar diagnostic
power compared with visual interpretation. Computerized measurements from maximal exercise
or recovery were equivalent or superior to all other measurements. Prediction equations
applied by computer were superior to single ECG measurements. -Blockers had no effect on test characteristics, whereas resting ST
depression was associated with decreased specificity and increased sensitivity.
Conclusions Computerized exercise ST measurements are comparable to visual ST
measurements by a cardiologist; computerized scores that included clinical and exercise
test results exhibited the greatest diagnostic power. Applying scores with a computer
allows the practicing physician to improve the diagnostic characteristics of the standard
exercise test. This approach is successful even when there is resting ST depression, thus
lessening the need for more expensive nuclear or imaging studies. (Am Heart J
- From the Cardiology Divisions at the Veterans Affairs
Palo Alto Health Care System, Stanford University; University of Texas at San Antonio;
Deborah Heart Institute; Sunnyside Biomedical; and St. Janoss Municipal Hospital.
- Submitted Dec. 16, 1997.
- Accepted Feb. 20, 1998.
- Reprint requests: Victor Froelicher, MD, Cardiology
Division (111 C), VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304.
- Copyright © 1998 by Mosby, Inc.