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Opinions/Hypotheses |

The Treadmill Test—Where To Stop and What Does It Mean?*

Gita Ramamurthy, MD; Jamie E. Kerr, MD; David Harsha, MD; Morton E. Tavel, MD, FCCP
Author and Funding Information

*From the Departments of Medicine (Drs. Ramamurthy and Tavel) and Sports Medicine (Dr. Harsha), St. Vincent Hospital, Indiana University; Indiana Heart Institute (Dr. Tavel), Indianapolis, IN; and the Department of Medicine (Dr. Kerr), Highland Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY.



Chest. 1999;115(4):1166-1169. doi:10.1378/chest.115.4.1166
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The prognostic utility of an exercise ECG test depends upon having an adequate workload to stress the cardiac system. A negative stress test, in which there are no adverse clinical or ECG findings, and in which an adequate workload is achieved, stratifies patients into a low-risk group. The 1997 American Heart Association guidelines imply that any index of workload—heart rate, rate-pressure product, or exercise duration in multiples of resting O2 consumption (METS)—could be used to indicate that adequate stress was achieved. However, while there is considerable evidence supporting the use of METS as a strong independent prognostic variable, there is less support for the use of rate-pressure product or heart rate. Indeed, there is evidence that a high heart rate at a low workload carries an adverse prognosis. Further research is needed to identify the number of METS achieved that would define an adequate workload. In the meantime, a review of the literature suggests that 7 to 10 METS is a reasonable ballpark figure of the minimum workload in patients with a negative stress test that would imply a favorable outcome.

Abbreviations: ETT = exercise treadmill test; METS = multiples of resting O2 consumption


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