American College of Cardiology

GIBBONS ET AL., Exercise Testing Guidelines
JACC Vol. 30, No. 1, July 1997:260-315

ACC/AHA Guidelines for Exercise Testing

Committee Members

Raymond J. Gibbons, MD, FACC, Chair, Gary J. Balady, MD, FACC, John W. Beasley, MD, FAFP, J. Timothy Bricker, MD, FACC, Wolf F. C. Duvernoy, MD, FACC, Victor F. Froelicher, MD, FACC, Daniel B. Mark, MD, MPH, FACC, Thomas H. Marwick, MD, FACC, Ben D. McCallister, MD, FACC, Paul Davis Thompson, MD, FACC, FACSM, William L. Winters, Jr., MD, FACC

James L. Ritchie, MD, FACC, Chair, Raymond J. Gibbons, MD, FACC, Vice Chair Melvin D. Cheitlin, Kim A. Eagle, MD, FACC, Timothy J. Gardner, MD, FACC, Arthur Garson, Jr., MD, MPH, FACC, Richard P. Lewis, MD, FACC, Robert A. O'Rourke, MD, FACC, Thomas J. Ryan, MD, FACC

Contents

I. Introduction

Exercise Testing Procedure

II. Exercise Testing in Diagnosis of Obstructive Coronary Artery Disease

Rationale
Pretest Probability
Diagnostic Characteristics and Test Performance
Believability Criteria for Diagnostic Tests
Diagnostic Accuracy of the Standard Exercise Test
Influence of Other Factors on Test Performance
Electrocardiographic Abnormalities
Overview of Confounders: Digoxin, Resting ST Depression, Left Ventricular Hypertrophy
ST-Segment Interpretation Issues

III. Risk Assessment and Prognosis in Patients With Symptoms or a Prior History of Coronary Artery Disease

Risk Stratification: General Considerations
Prognosis of Coronary Artery Disease: General Considerations
Risk Stratification With the Exercise Test
Use of Exercise Test Results in Patient Treatment

IV. After Myocardial Infarction

Exercise Test Logistics
Risk Stratification and Prognosis
Activity Counseling
Cardiac Rehabilitation
Summary

V. Exercise Testing Using Ventilatory Gas Analysis

VI. Special Groups: Women, Asymptomatic Individuals, and Postrevascularization Patients

Women
Diagnosis of Coronary Artery Disease in the Elderly
Exercise Testing in Asymptomatic Individuals Without Known Coronary Artery Disease
Valvular Heart Disease
Exercise Testing Before and After Revascularization
Investigation of Heart Rhythm Disorders

VII. Pediatric Testing: Exercise Testing in Children and Adolescents

Differences Between Pediatric and Adult Testing
Exercise Testing for specific Pediatric and Congenital Cardiac Problems

References

Index

"ACC/AHA Guidelines for Exercise Testing" was approved by the American College of Cardiology Board of Trustees in March 1997 and the American Heart Association Science Advisory and Coordinating Committee in April 1997. When citing this document, the American College of Cardiology and the American Heart Association request that the following citation format be used: Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WFC, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD, Winters WL Jr, Yanowitz FG. ACC/AHA guidelines for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997;30:260-315. A single reprint of this document (the complete Guidelines) is available by calling 800-253-4636 (US only) or writing American College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Ask for reprint No. 71-0112. To obtain a reprint of the Executive Summary published in the July 1 issue of Circulation, ask for reprint No. 71-0111. To purchase additional reprints (specify version reprint number): up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342, or E-mail pubauth@amhrt.org. To make photocopies for personal or educational use, call the Copyright Clearance Center, 508-750-8400.