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Exercise ECG Diagnostic Accuracy — EECC MCQ

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EasyCardiac ImagingExercise ECG Diagnostic AccuracyEECC

A medical student asks about the difference between sensitivity and specificity of diagnostic tests in cardiology. Exercise ECG has a sensitivity of ~65% and specificity of ~70% for obstructive CAD. What does this mean clinically?

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Correct answer: C — A sensitivity of 65% means 35% of patients with CAD will have a false-negative test (missed disease), and specificity of 70% means 30% of patients without CAD will have a false-positive result — this is why the 2024 ESC CCS Guidelines prefer imaging-based tests with higher diagnostic accuracy

Sensitivity (true positive rate) is the probability that a test correctly identifies disease when present. Specificity (true negative rate) is the probability that a test correctly identifies the absence of disease. Exercise ECG has modest sensitivity (~65%) and specificity (~70%) for obstructive CAD, meaning: (1) ~35% false-negative rate (missing significant CAD — particularly concerning as these patients may be falsely reassured); (2) ~30% false-positive rate (leading to unnecessary invasive angiography). The 2024 ESC CCS Guidelines have de-emphasised exercise ECG as a diagnostic test (Class IIb), preferring imaging-based functional tests (stress echo, SPECT/PET, stress CMR) and anatomical tests (CTCA), which have sensitivity and specificity >80-90%. Exercise ECG retains value for: exercise capacity/functional assessment, symptom correlation, BP response, and prognostication.

Reference: ESC (2024): CCS Guidelines