Stress testing: A contribution from Dr Robert A. Bruce, father of exercise cardiology

ABSTRACT: Recognizing the important physiological relationship between the heart and exercise, Dr Robert Arthur Bruce undertook research that revolutionized the way physicians approach cardiac disease. His contributions to exercise physiology and cardiology have shaped many concepts used today in clinical practice. He is best known for developing a protocol for the exercise treadmill test known as the Bruce protocol. Because of its universality, reproducibility, and practicality, the protocol remains one of the most widely used methods for diagnosing ischemic heart disease. Patients commonly start exercising on a treadmill set at 1.7 miles per hour and a 10% grade, and increase to a maximum speed of 6.0 miles per hour and a 22% grade. The aim of testing is to detect the presence of coronary artery disease by looking for electro-cardiogram changes during times of stress. The sensitivity of exercise treadmill testing is estimated to be 70% and the specificity to be 80%. These values range broadly depending on multiple factors, including the definition of a positive test result. The strongest predictor of survival found on exercise treadmill testing is exercise capacity. Treadmill testing can also be combined with imaging modalities to further increase sensitivity and specificity, making it one of the first tests considered when coronary artery disease is suspected in a patient. 

Autor / Fonte:Issue: BCMJ, Vol. 58, No. 2, March 2016, page(s) 70-76 Articles Michael W. Luong, MD, FRCPC, M. Ignaszewski, MD, C.M. Taylor MD, FACC