Abnormal exercise electrocardiogram in an asymptomatic person--what next?

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Current guidelines lack clarity for interpreting positive exercise electrocardiography (ECG) tests in asymptomatic individuals.
• Existing data suggest varying diagnostic pathways based on test positivity, but a standardized approach is needed.

Purpose of the Study:

• To outline an evidence-based approach for evaluating asymptomatic individuals with positive exercise ECG results.
• To clarify the role of different diagnostic modalities in detecting ischemic heart disease.

Main Methods:

• Review of available data on the evaluation of positive exercise ECG tests.
• Analysis of recommendations for coronary angiography, cinefluoroscopy, and radionuclide studies.
• Consideration of sex-specific differences in diagnostic test performance.

Main Results:

• Strongly positive exercise ECG tests warrant coronary angiography.
• Mild to moderately positive tests may require cinefluoroscopy, with coronary calcification indicating the need for angiography.
• Positron emission tomography demonstrates high specificity and sensitivity, potentially offering cost-effectiveness despite higher initial costs.

Conclusions:

• A structured approach is necessary for positive exercise ECG results in asymptomatic patients.
• Positron emission tomography may be a cost-effective diagnostic tool for coronary artery disease.
• Further research is needed, especially regarding diagnostic strategies in women due to low specificity of ST changes.