If the test is positive, i.e. there is significant evidence of cardiac ischaemia, then this allows one to assess the probability that the patient has ischaemic heart disease. About 75% of patients with ischaemic heart disease have a positive exercise test. There is a false positive rate of 5%, i.e. 5% of patient's with a positive test will have normal arteries.
The predictive value of the test increases with the more positive the exercise test result. If there is sloping of the ST segment then a down sloping ST segment is far more significant than an upsloping ST segment.
Reciprocal ST depression induced by exercise is usually associated with extensive Q wave infarctions and persistent occlusion of the artery related to the infarct. This phenomenom does not seem to be an indicator for reversible ischaemia and should not be used as a non-invasive marker of multivessel disease in the assessment of requirements for further investigation soon after an acute MI.
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