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Exercise Test Prognostic Value — EECC MCQ

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EasyCoronary Artery DiseaseExercise Test Prognostic ValueEECC

A 60-year-old man with stable CCS undergoes a treadmill exercise test using the Bruce protocol. He achieves 10 METs, reaches 95% of age-predicted maximum heart rate, has no chest pain, and no ST changes. His blood pressure rises appropriately from 130/80 to 190/85 mmHg. What is the prognostic significance?

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Correct answer: D — This is a strongly negative test associated with excellent prognosis — exercise capacity >10 METs and absence of ischaemic changes at near-maximal heart rate have a very high negative predictive value for significant CAD

Exercise ECG testing provides both diagnostic and prognostic information. The Duke Treadmill Score integrates exercise duration, ST deviation, and angina index. Favourable prognostic markers include: (1) high exercise capacity (>10 METs — the single strongest predictor of survival); (2) achievement of target heart rate (>85% APMHR) without ischaemia; (3) normal blood pressure response (appropriate rise during exercise); (4) absence of arrhythmias. This patient's test is strongly negative with excellent exercise capacity, associated with an annual cardiac event rate <1%. The 2024 ESC CCS Guidelines position exercise ECG as a diagnostic tool primarily when imaging is unavailable, but its prognostic value from exercise capacity assessment remains important regardless of diagnostic accuracy.

Reference: ESC (2024): CCS Guidelines