• Abdul Wajid Khan Faisal
  • Abdul Rehman Abid
  • Muhammad Azhar


Background: To study the factors which predetermine the coronary artery disease in patientshaving positive Exercise Tolerance Test (ETT) after comparing the ETT test results and coronaryangiographic findings in true positive and false positive groups. Methods: This Cross-sectionalstudy was conducted at Punjab Institute of Cardiology, Lahore from January 1, 2004 to December31, 2004. All patients who had ETT done for chest pain diagnosis were studied. Patients wereadvised coronary angiography if ETT was positive for exercise induced ischaemia. One hundredand forty eight patients had coronary angiography done after positive ETT. Patients were dividedinto two groups depending upon the angiographic findings, i.e., true positive and false positive.Both groups were compared with each other. Results: Out of 148 patients, 126 (85.1%) patientshad true positive ETT and 22 (14.9%) patients had false positive ETT. The mean age of patients intrue positive group was 48.969.08 years and 50.97.85 years in false positive group. Onehundred and eighteen (93.7%) male patients and 8 (6.3%) female patients had true positive ETT,whereas 14 (63.6%) males and 8 (36.4%) females had false positive ETT (p<0.0001). There wasno statistically significant difference in the two groups in comparison of age and otherconventional risk factors like diabetes mellitus, hypertension, smoking, family history anddyslipidemia. Abnormal resting ECG had a statistically significant difference between the groups(p<0.04), likewise is hypertensive haemodynamic response during ETT (p<0.003). The symptomlimited ETT as compared to no symptoms during ETT also conferred a statistically significantdifference between the groups (p<0.0001). Strongly positive ETT was also associated with truepositive ETT (p<0.002). Amongst the vessels involved the most common was the LAD 113(89.7%), followed by LCX 80 (63.5%) and the RCA 72 (57.1%). Most of the patients 51 (40.5%)had three vessel disease as compared to SVD 34 (27%). Conclusion: It can be concluded thatamongst the patients who have positive ETT, females with abnormal resting ECG, who achievetarget heart rate and have a hypertensive haemodynamic response with no symptoms are likely tohave a false positive test result. Conversely male patients with normal resting ECG who do notachieve target heart rate, have a normotensive haemodynamic response and a strongly positive,symptom limited ETT are likely to have a true positive treadmill test result.Keywords: Exercise tolerance test, Coronary artery disease, Coronary angiography, true positive,false positive.


Ashley E A, Myers J, Froelicher V. Exercise testing in

clinical medicine. Lancet 2000;356:1592–7.

Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P,

Colombo A, et al. Exercise-induced ST depression in the

diagnosis of coronary artery disease: a meta analysis.

Circulation 1989;80:87–98.

Detrano R, Gianrossi R, Mulvihill D, Lechman K, Dubach P,

Colombo A, et al. Exercise-induced ST segment depression

in the diagnosis of multivessel coronary disease: a meta

analysis. J Am Coll Cardiol 1989;14:1501–8.

Shareiff S, Shah-e-Zaman K. Exercise Tolerance Test in patients

presenting with chest pain and normal electrocardiogram. J Coll

Physicians Surg Pak 2002;12(6):348–52.

Shareiff S, Shah-e-Zaman K. Sensitivity and Specificity of

Exercise Tolerance Test in patients with chest pain and normal

baseline Electrocardiogram. Pak J Cardiol 2002;13(3-4):91–5.

Zipes DP, Libby P, Bonow RO, Braunwald E. Exercise stress

testing, In Braunwald’s Heart Disease.7th ed 2005;

Philadelphia Elsevier Saunders: p153–86.

Lipinski M, Do D, Morise A, Froelicher V. What percent

luminal stenosis should be used to define angiographic

coronary artery disease for noninvasive test evaluation. Ann

Noninvasive Electrocardiol 2002;7(2):98–105.

Kwok YS, Kim C, Grady D, Redberg RF. Exercise testing

for coronary artery disease diagnosis in women: a meta

analysis. Circulation 1995;94:I-497.

Zhao D, Freeman DH, de Flippi CR. A meta-analysis of gender

differences in exercise testing. Circulation 1995;94:I-497.

Walling AD, Crawford MH. Exercise testing in women with

chest pain: applications and limitations of computer analysis.

Coronary Artery Dis 1993;4:783–9.

Okin PM, Kligfield P. Identifying coronary artery disease in

women by heart rate adjustment of ST-segment depression

and improved performance of linear regression over simple

averaging methods with comparison to standard criteria. Am

J Cardiol 1992;69: 297–302.

Robert AR, Melin JA, Detry JM. Logistic discriminant analysis

improves diagnostic accuracy of exercise testing for coronary

artery disease in women. Circulation 1991;83:1202–9.

Hachamovitch R, Berman DS, Kiat H. Effective risk

stratification using exercise myocardial perfusion SPECT in

women: gender-related differences in prognosis nuclear

testing. J Am Coll Cardiol 1996;28:34–44.

Morise AP, Diamond GA, Detrano R, Bobbio M. Incremental

value of exercise electrocardiography and thallium-201 testing

in men and women for the presence and extent of coronary

artery disease. Am Heart J 1995;130:267–76.

Williams MJ, Marwick TH, O’Gorman D, Foale RA.

Comparison of exercise echocardiography with an exercise

score to diagnose coronary artery disease in women. Am J

Cardiol 1994;74:435–8.

Bickell NA, Pieper KS, Lee KL. Referral patterns for

coronary artery disease treatment: gender bias or good

clinical judgement? Ann Intern Med 1992;116:791–7.

Alexander KP, Shaw LJ, Shaw LK, Delong ER, Mark DB,

Peterson ED. Value of exercise treadmill testing in women. J

Am Coll Cardiol 1998;32(6):1657–64.

Fearon W, Lee D, Froelicher V. The effect of resting ST

segment depression on the diagnostic characteristics of the

exercise treadmill test. J Am Coll Cardiol 2000;35:1206–11.

Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher

GF, Froelicher VF, et al. ACC/AHA 2002 guideline update

for exercise testing. Summary article: A report of the

ACC/AHA Task Force on Practice Guidelines (Committee to

Update the 1997 Exercise testing Guidelines). J Am Coll

Cardiol 2002;40:1531–40.

Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel

R, Fleg J, et al. Exercise standards for testing and training: A

statement for health care professionals from the American

Heart Association. Circulation 2001;104:1694–740.

Ellestad MH: Stress Testing: Priciples and Practice. 4th ed.

Philadelphia, FA Davis, 1996:21–34.

Froelicher VF, Myers J. Exercise and the Heart. 4th ed.

Philadelphia, WB Saunders, 2000:452–59.


Most read articles by the same author(s)

1 2 > >>