Test-results-noninvasive evaluation of CAD

• HR (must achieve ≥85% of max pred HR [220-age] for exer. test to be dx), BP response, peak double product (HR × BP; nl >20k), HR recovery (HRpeak – HR1 min later; nl >12)

• Max exercise capacity achieved (METS or min); occurrence of symptoms

• ECG ∆s: downsloping or horizontal ST ↓ (≥1 mm) 60–80 ms after QRS predictive of CAD (but does not localize ischemic territory); however, STE highly predictive & localizes

• Duke treadmill score = exercise min – (5 × max ST dev) – (4 × angina index) [0 none, 1 nonlimiting, 2 limiting]; score ≥5 → <1% 1-y mort; –10 to + 4 → 2–3%; ≤–11 → ≥5%

• Imaging: radionuclide defects or echocardiographic regional wall motion abnormalities

reversible defect = ischemia; fixed defect = infarct; transient isch dilation → ? severe 3VD

false ⊕: breast → ant defect; diaphragm → inf defect. False ⊖: balanced (3VD) ischemia.