What is the role of exercise treadmill testing in perioperative cardiac management?

Updated: Feb 04, 2019
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

Exercise stress testing is useful in patients who are able to exercise, but a significant percentage of patients undergoing noncardiac surgery are unable to reach the maximal predicted heart rate, given the magnitude of their concomitant vascular disease. In those individuals able to walk the treadmill, the sensitivity and specificity for predicting coronary artery disease are 65% and 85%, respectively.

Studies have confirmed that exercise stress testing does not provide a high NPV. Physiologically, exercise increases the heart rate and systemic vascular resistance, thus increasing oxygen consumption by the myocardium. Therefore, a positive test result indicates a high risk of developing ischemia perioperatively. However, many ischemic events occurring intraoperatively are not associated with changes in the heart rate or blood pressure; therefore, the minimal threshold of myocardial oxygen utilization to evoke ischemia is not reached, and the significance of a negative stress test result is misleading.


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