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June 12, 1967

Postexercise Electrocardiogram in Arteriosclerotic Heart DiseaseIts Value in Diagnosis and Prognosis

Author Affiliations

From the Medical Department (Dr. Robb) and Statistical Bureau (Mr. Marks) of the Metropolitan Life Insurance Company, New York. Dr. Robb and Mr. Marks are now retired.

JAMA. 1967;200(11):918-926. doi:10.1001/jama.1967.03120240046007

An evaluation of the electrocardiographic exercise test in the diagnosis and prognosis of latent arteriosclerotic heart disease was made using improved methods of performance and interpretation. The evaluation was based on 2,224 male applicants for life insurance given the test. A long-term follow-up of these cases disclosed: Ischemic ST segment depression after exercise is pathognomonic of coronary insufficiency for all practical purposes. The amount of ischemic ST depression indicates the degree of the insufficiency and the prognosis. Ischemic response involving multiple leads has a worse prognosis than that involving one lead. In the vast majority of cases, a nonischemic response—ST junction depression, negative response, or T-wave change—excludes latent coronary insufficiency of significant degree. Preexercise T-wave abnormality due to coronary disease is distinguished by an ischemic response. In this study, the postexercise electrocardiogram gave more reliable evidence of latent or silent coronary disease than did the medical history. No adverse effect resulted from the test.