Sensitivity and specificity of exercise ECG in heart disease

doi:10.1136/bmj.a3098

Published 24 December 2008, doi:10.1136/bmj.a3098
Cite this as: BMJ 2008;337:a3098

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Exercise ECGs in angina

Sensitivity and specificity of exercise ECG in heart disease

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In a cohort of patients considered (and proved) to be at highrisk of angina, exercise electrocardiography (ECG) had a sensitivityof only 53% for identifying those who would have an acute coronaryevent in the next 2.5 years.¹

At first sight this seems quite low. The American Heart Associationguidelines on exercise ECG testing quote a sensitivity and specificityof 68% and 77% for detecting significant coronary disease atangiography. This figure is based on a meta-analysis of 24 000patients.

However, not all patients had angiography in most of the studiesin the meta-analysis. Far more patients with positive resultson exercise ECG have angiography than do those with negativeresults. This artificially raises the sensitivity and depressesthe specificity. When the gold standard is clinically significantcoronary artery disease at angiography, it is clearly necessaryfor all patients to have both exercise ECG and angiography.When Froelicher . . . [Full text of this article]

Kevin Barraclough, general practitioner¹

¹ Painswick GL6 6TY

k.barraclough@btinternet.com

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BMJ 2008 337: a2240. [Abstract] [Full Text] [PDF]