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Related Experiment Videos

The "false negative" treadmill exercise test and left ventricular dysfunction.

N Kramer, A Susmano, R B Shekelle

    Circulation
    |April 1, 1978
    PubMed
    Summary
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    Exercise stress tests can miss coronary artery disease, especially when left ventricular dysfunction is present. These false negative results indicate underlying heart abnormalities despite a normal exercise response.

    Area of Science:

    • Cardiology
    • Diagnostic Imaging
    • Exercise Physiology

    Background:

    • Graded exercise testing (GXT) is a common tool for diagnosing coronary artery disease (CAD).
    • However, false negative responses can lead to underdiagnosis and delayed treatment.
    • Understanding factors contributing to false negatives is crucial for improving diagnostic accuracy.

    Purpose of the Study:

    • To evaluate the sensitivity, specificity, and false negative rates of GXT in symptomatic patients.
    • To identify patient characteristics and underlying cardiac conditions associated with false negative GXT results.
    • To explore the relationship between false negative responses and left ventricular function.

    Main Methods:

    • Retrospective analysis of 115 symptomatic patients undergoing GXT, coronary angiography, and left ventriculography.

    Related Experiment Videos

  • Calculation of sensitivity, specificity, and false negative rates for GXT.
  • Comparison of ventriculographic and hemodynamic data between true positive and false negative groups.

    • Main Results:

    • GXT demonstrated a sensitivity of 79%, specificity of 81%, and a false negative rate of 21%.
    • False negative responses were not significantly different across varying degrees of coronary artery disease (single, double, or triple vessel disease).
    • Patients with false negative GXT showed significant ventriculographic and hemodynamic abnormalities, including impaired ventricular motion and higher rates of occluded vessels supplying abnormal segments.

    Conclusions:

    • Left ventricular dysfunction is a significant factor contributing to false negative exercise test responses.
    • Abnormal myocardial segments supplied by occluded vessels may be related to the absence of an "ischemic response" on GXT.
    • GXT accuracy can be limited in patients with underlying left ventricular abnormalities.