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Optimising diagnostic accuracy with the exercise ECG: opportunities for women and men with stable ischaemic heart disease
  1. Leslee J Shaw1,
  2. Joe X Xie1,
  3. Lawrence M Phillips2,
  4. Abhinav Goyal1,
  5. Harmony R Reynolds2,
  6. Daniel S Berman3,
  7. Michael H Picard4,
  8. Balram Bhargava5,
  9. Gerard Devlin6,
  10. Bernard R Chaitman7
  1. 1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA
  3. 3Department of Imaging, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  4. 4Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Professor of Cardiology, Cardiothoracic Sciences Centre, and Executive Director, Stanford India Biodesign Centre, School of International Biodesign (SIB), All India Institute of Medical Sciences, New Delhi, India
  6. 6Department of Medicine, Division of Cardiology, New Zealand Heart Foundation, Waikato Hospital, Hamilton, New Zealand, USA
  7. 7Department of Medicine, Division of Cardiology, St Louis University School of Medicine, St Louis, Missouri, USA
  1. Correspondence to Dr Leslee J Shaw, Room 529, 1462 Clifton Rd NE, Emory University School of Medicine, Atlanta, GA 30322, USA; lshaw3{at}


The exercise ECG is an integral part within the evaluation algorithm for diagnosis and risk stratification of patients with stable ischaemic heart disease (SIHD). There is evidence, both older and new, that the exercise ECG can be an effective and cost-efficient option for patients capable of performing at maximal levels of exercise with suitable resting ECG findings. In this review, we will highlight the major dilemmas in interpreting suspected coronary artery disease symptoms in women and identify optimal strategies for employing exercise ECG as a first-line diagnostic test in the SIHD evaluation algorithm. We will highlight current evidence as well as recent guideline statements on this subject.

Trial registration number NCT01471522; Pre-results.


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