Role of exercise testing in predicting sudden death

The exercise test can be utilized to identify a subset of patients with coronary heart disease who are at increased risk of subsequent cardiac mortality including sudden cardiac death. The exercise test variables that best identify these high risk patients differ according to clinical subsets, but exercise duration, ST segment depression and ventricular arrhythmias on the electrocardiogram are the most important variables. In the clinical setting, the exercise test is of limited value for identifying the patient at risk for developing sudden cardiac death because its sensitivity and specificity are not high enough. However, the exercise test does provide prognostic information that is independent of other clinical variables and it may prove to be of clinical utility when combined with multiple other prognostic variables.