Treadmill Test - Changing Paradigm

Exercise or stress ECG referred to as treadmill test (TMT) has been used for the last several decades for the diagnosis of obstructive coronary artery disease (CAD) but is limited by its low sensitivity and specificity. The advent of other modalities which combines imaging such as echocardiography, nuclear perfusion imaging, computed tomography (CT), and magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of myocardial ischemia. Anatomic imaging of coronary arterial obstruction by CT angiography has also emerged as a highly sensitive and specific test to rule out CAD. TMT now moved from diagnosis of myocardial ischemia to assessment of valvular heart disease, congenital heart disease, pulmonary hypertension, arrhythmia, diastolic dysfunction, genetic CV disease, and peripheral arterial disease. It remains an important test for assessing exercise-induced symptoms, functional capacity, exercise duration, heart rate, and blood pressure during exercise and during recovery after exercise. Of its low sensitivity and specificity TMT should be avoided as a routine test in asymptomatic individuals and in persons with a low probability of CAD. However, due to its wide availability, low-cost and easy interpretation, when used judiciously in cases of moderate to a high probability of CAD, it remains invaluable.