The Clinical Use of Nonimaging Exercise Stress Testing

Exercise stress testing is an exceptionally useful cardiovascular test providing a wealth of information that can be used in patient management. It can be used in the diagnosis and/or management of chest pain, hypertension, arrhythmia, and heart failure.  Non-imaging exercise stress testing not only helps evaluate the etiology of clinical symptoms but also provides an opportunity to evaluate ECG changes with exercise, total exercise capacity, heart rate response or chronotropic index, blood pressure response, heart rate recovery, and to make estimates of the risk of coronary artery disease using tools such as the Duke Treadmill Score.  These parameters, individually and collectively, provide valuable information on the likelihood of disease and an individual’s prognosis. In addition, exercise testing is inexpensive, quick and widely available compared to imaging studies.  This review contains 6 figures, 5 tables, and 68 references.  Keywords: blood pressure response, chronotropic incompetence, coronary artery disease, Duke Treadmill Score, exercise physiology metabolic equivalents (METs), exercise stress test, exercise treadmill test, exercise-induced hypertension, heart rate recovery, maximal exercise capacity, ST-segment deviation