Duke Treadmill Score — EECC MCQ
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Correct answer: B — DTS ≤ -11 indicates high risk (annual mortality >5%) — the score integrates exercise duration, ST deviation, and angina: DTS = exercise time (minutes, Bruce protocol) - (5 × max ST deviation mm) - (4 × angina index); this patient needs urgent invasive assessment
The Duke Treadmill Score (DTS) provides prognostic stratification after exercise ECG: DTS = exercise time (minutes) - (5 × max ST deviation in mm) - (4 × angina index, where 0=none, 1=non-limiting, 2=exercise-limiting). Risk categories: ≥+5 = low risk (annual mortality <1%); -10 to +4 = moderate risk (1-3%); ≤-11 = high risk (>5%). This patient's DTS of -15 indicates high risk, suggesting: short exercise duration (poor functional capacity), significant ST deviation (≥2 mm), and/or exercise-limiting angina. The 2024 ESC CCS Guidelines note that while exercise ECG diagnostic accuracy is limited, its prognostic value (through DTS, exercise capacity, and haemodynamic response) remains useful. High-risk DTS warrants urgent coronary angiography rather than additional non-invasive testing.
Reference: ESC (2024): CCS Guidelines