ACC/AHA 2002 Guideline Update for Exercise Testing: Summary Article

Name: Work Video:
Duration: 3 min 30 s
Raymond J. Gibbons; Gary Balady; J. Timothy Bricker; Bernard Chaitman; Gerald F. Fletcher; Victor F. Froelicher; Daniel B. Mark; Ben D. McCallister; Aryan N. Mooss; Michael G. O’Reilly; William L. Winters; Raymond J. Gibbons; Elliott M. Antman; Joseph S. Alpert; David P. Faxon; Valentı́n Fuster; Gabriel Gregoratos; Loren F. Hiratzka; Alice K. Jacobs; Richard O. Russell; Sidney C. Smith
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3695, 4158, 4246], 'mentioned': [518], 'basis': [521, 1029, 2647, 4163, 4211], 'new': [523, 655, 955, 1604, 1987, 2665, 2811, 2815, 3115, 4079, 4274], 'understanding': [524], 'evidence.': [526], 'Minor': [527], 'verbiage': [530], 'references': [532, 656, 663], 'discouraged.The': [534], 'ACC/AHA': [535, 836, 1033, 3411], 'exercise': [538, 1120, 1158, 1193, 1234, 1311, 1535, 1559, 1587, 2038, 2121, 2156, 2221, 2370, 2387, 2453, 2461, 2501, 2564, 2651, 2671, 2692, 2739, 2784, 3400, 3592, 3676, 3750, 3784, 3793, 3822, 3866, 3902, 3940, 3966, 4034, 4070, 4147, 4220, 4262], 'testing': [539, 1226, 1235, 2040, 2565, 2652, 2828, 3235, 3243, 3401, 3543, 3569, 3596, 3609, 3686, 3751, 3794, 3903, 4071, 4148, 4263], 'that': [540, 568, 588, 608, 859, 915, 980, 1001, 1077, 1220, 1321, 1483, 1802, 1823, 2015, 2589, 2659, 2683, 2697, 2699, 2923, 3471, 4051], 'were': [541, 973, 992, 1577, 2123, 2329, 2341, 2351, 2424, 2582, 2599, 3299, 3929, 4183, 4224], 'published': [542, 1988, 2816, 4145], 'have': [545, 1148, 1340, 1348, 1455, 1744, 1773, 1798, 2360, 2439, 2505, 2983, 2994, 3587, 3615, 3705, 3714, 3728, 4106, 4117, 4260], 'now': [546, 1721, 3026], 'been': [547, 1095, 1149, 1204, 1745, 1774, 2048, 2506, 3429, 3588, 3616, 4064, 4118, 4150], 'updated.': [548], 'The': [549, 620, 947, 961, 1160, 1217, 1288, 1398, 1425, 1614, 2240, 2435, 3352, 3840, 3917, 4082, 4277], 'full-text': [550, 1136], 'incorporating': [552], 'updated': [554], 'material': [555, 1110, 1125, 2010], 'available': [557, 937, 2160, 3788], 'Internet': [560, 644], '(www.acc.org': [561], 'www.americanheart.org)': [563], 'both': [565, 1333, 2110, 2118, 2133, 2562, 3958], 'a': [566, 585, 606, 617, 725, 860, 878, 886, 995, 1275, 1302, 1355, 1362, 1378, 1390, 1413, 1518, 1532, 1805, 1906, 1916, 1930, 2079, 2089, 2149, 2178, 2309, 2391, 2414, 2457, 2509, 2519, 2551, 2573, 2669, 2676, 2685, 2746, 2919, 2929, 3206, 3339, 3345, 3387, 3525, 3626, 3653, 3690, 3715, 3732, 3772, 3815, 3825, 3959, 3964, 3971, 3984, 4008, 4085, 4217, 4235, 4267], 'version': [567, 587, 645], 'shows': [569], 'strike-over': [577], '(deleted': [578], 'text)': [579, 583], 'highlighting': [581], '(new': [582], '“clean”': [586], 'fully': [589, 2926], 'incorporates': [590, 1986], 'changes.This': [592], 'article': [593], 'describes': [594], '10': [596], 'change': [600, 1708, 1725, 2257, 2458, 2704], 'reflected': [601, 4052], 'format': [607, 1047], 'we': [609], 'hope': [610], 'can': [611, 2801, 3509, 3520, 3610, 3635, 3646], 'be': [612, 926, 1434, 2679, 2767, 2802, 2925, 2977, 3338, 3477, 3511, 3521, 3546, 3571, 3599, 3611, 3636, 3647, 3680, 4027], 'read': [613], 'understood': [615], 'as': [616, 847, 1515, 1562, 2096, 2148, 2244, 2375, 2456, 2518, 2642, 2932, 3650, 3669, 3803, 3805, 4042, 4264], 'stand-alone': [618], 'document.': [619], 'table': [621, 1615, 2930, 2936, 3473], 'contents': [623], 'from': [624, 975, 994, 1008, 2183, 2186, 2368, 2459, 2710, 2950, 3197, 3223, 3991, 4029, 4228], 'full-length': [626, 643], 'guideline': [627], '(see': [628, 1599, 1734, 1763, 1794, 1976, 3660, 4078, 4273], 'next': [629, 4023], 'page)': [630, 1602], 'indicates': [631, 2876, 3167], 'location': [633], 'these': [635, 652, 1215, 1375, 1404, 1463, 3871, 4132, 4139], 'changes.': [636, 653], 'Interested': [637], 'readers': [638], 'referred': [640, 1308, 2425, 2498], 'completely': [647], 'understand': [648], 'context': [650], 'All': [654], 'appear': [657, 664], 'boldface': [659], 'type;': [660], 'all': [661, 3191, 3200, 3878], 'original': [662, 929, 1107, 2013], 'normal': [666, 1825, 2747, 2781, 2789, 3691], 'type.Table': [667], 'ContentsPreamble263': [669], 'I.Introduction263Exercise': [670], 'Procedure264General': [672], 'Overview264Indications': [673], 'Safety265Equipment': [675], 'Protocols265Exercise': [677], 'End': [678], 'Points265Interpretation': [679], 'Test265Cost': [683], 'Availability265Clinical': [685], 'Context266II.Exercise': [686], 'Diagnose': [689], 'Obstructive': [690], 'Coronary': [691, 729, 736, 781, 2027, 3311, 3889], 'Artery': [692, 730, 737, 782, 2028, 3890], 'Disease266Rationale268Pretest': [693], 'Probability268Diagnostic': [694], 'Characteristics': [695], 'Test': [697, 745, 752, 761, 1092], 'Performance268Believability': [698], 'Criteria': [699], 'Diagnostic': [701], 'Tests270Diagnostic': [702], 'Accuracy': [703], 'Standard': [706], 'Test270Confounders': [708], 'Stress': [710], 'ECG': [711, 1807, 1844, 1852, 2693, 2734, 2749, 3108, 3152, 3693, 4221], 'Interpretation': [712, 715], '(Modification': [713, 759, 799, 810, 814], 'I)273ST-Segment': [714], 'Issues273III.Risk': [716], 'Assessment': [717], 'Prognosis': [719], 'Patients': [721, 1646, 1664, 1698, 1713, 1840, 1847, 1914, 1928, 1944, 1958, 2774, 2869, 3419, 3450, 4205], 'With': [722, 742, 2317, 2870, 3309, 3420], 'Symptoms': [723], 'Prior': [726], 'History': [727], 'Disease274Risk': [731], 'Stratification:': [732], 'General': [733, 739], 'Considerations274Prognosis': [734], 'Disease:': [738], 'Considerations274Risk': [740], 'Stratification': [741, 763], '(Modifications': [746, 794], 'II,': [747, 839], 'III,': [748], 'IV)275Use': [749], 'Results': [753], 'Patient': [755], 'Treatment280IV.After': [756], 'Myocardial': [757, 2866, 3426], 'Infarction': [758, 2867, 3427], 'V)280Exercise': [760], 'Logistics281Risk': [762], 'Prognosis282Activity': [765], 'Counseling284Cardiac': [766], 'Rehabilitation285Summary285V.Exercise': [767], 'Using': [769, 3150], 'Ventilatory': [770], 'Gas': [771], 'Analysis285VI.Special': [772], 'Groups:': [773], 'Women,': [774], 'Asymptomatic': [775, 789], 'Individuals,': [776], 'Postrevascularization': [778], 'Patients287Women287Diagnosis': [779], 'Disease': [783, 798, 3164, 3891], 'Elderly289Exercise': [786], 'Persons': [790], 'Without': [791], 'Known': [792], 'CAD': [793, 1703, 2549, 3377, 4239, 4280], 'VI,': [795], 'VII)290Valvular': [796], 'VIII)293Exercise': [800], 'Before': [802], 'After': [804], 'Revascularization294Investigation': [805], 'Rhythm': [808], 'Disorders': [809], 'IX)296Evaluation': [811], 'Hypertension': [813], 'X)NewVII.Pediatric': [815], 'Children': [820], 'Adolescents297Differences': [822], 'Between': [823], 'Pediatric': [824, 831], 'Adult': [826], 'Testing297Exercise': [827], 'Specific': [830, 1655, 1689], 'Congenital': [833], 'Cardiac': [834], 'Problems298Appendixes302References303The': [835], 'classifications,': [837], 'I,': [838], 'III': [841, 1942, 3038], 'used': [843, 1221, 4119], 'summarize': [845], 'indications': [846, 3802], 'follows:Class': [848], 'I:': [849], 'Conditions': [850, 870, 906], 'which': [852, 872, 908, 1352, 1507, 3743], 'there': [853, 873, 909, 1503, 2654], 'evidence': [855, 876, 911, 939, 950, 965, 1829, 1989, 2658, 2817, 3730, 3740, 3787], 'and/or': [856, 877, 912, 1953, 1967], 'general': [857, 913, 2941], 'agreement': [858, 914], 'given': [861, 1022], 'procedure': [862, 887], 'treatment': [864], 'useful': [866, 3436], 'effective.Class': [868], 'II:': [869], 'conflicting': [875], 'divergence': [879], 'opinion': [881], 'about': [882], 'usefulness/efficacy': [884], 'treatment.IIa:': [889], 'Weight': [890], 'evidence/opinion': [892], 'favor': [895], 'usefulness/efficacy.IIb:': [897], 'Usefulness/efficacy': [898], 'less': [900, 1681, 2334, 2472, 3142], 'well': [901], 'established': [902], 'evidence/opinion.Class': [904], 'III:': [905], 'procedure/treatment': [917], 'not': [919, 934, 1431, 1466, 1500, 1555, 2140, 2159, 2170, 3696, 4037], 'useful/effective': [920], 'some': [923, 1445], 'cases': [924], 'may': [925, 2993, 3337, 3343], 'harmful.In': [927], 'guideline,': [930], 'committee': [932], 'did': [933], 'rank': [935, 1019], 'scientific': [938], 'A,': [942], 'B,': [943], 'C': [945], 'fashion.': [946], 'level': [948, 3962], 'provided': [952], 'recommendations': [956, 1598, 1605, 1617], 'appearing': [957], 'update.': [960], 'weight': [962], 'was': [966, 1021, 1026, 1406, 1420, 1430, 1547, 1589, 2100, 2139, 2157, 2169, 2401, 2486, 2545, 3236, 3244, 3847], 'ranked': [967], 'highest': [968], '(A)': [969], 'if': [970, 989, 3185], 'data': [972, 991, 1464, 2182, 2702], 'derived': [974, 993, 1172], 'multiple': [976], 'randomized': [977, 999], 'clinical': [978, 1710, 1727, 1918, 1932, 2114, 2649, 3265, 3303, 3432, 4186], 'trials': [979, 1000], 'involved': [981, 1002], 'large': [982, 1409], 'numbers': [983, 1004], 'patients': [985, 1006, 1256, 1294, 1300, 1328, 1339, 1347, 1373, 1394, 1489, 1569, 1610, 1733, 1762, 1793, 1975, 2065, 2145, 2185, 2497, 2555, 2630, 2638, 2709, 2756, 2819, 3203, 3275, 3298, 3488, 3519, 3531, 3555, 3582, 3614, 3634, 3645, 3671, 3688, 3701, 3765, 3799, 3833, 3855, 3946, 3980, 4102, 4156, 4182, 4258], 'intermediate': [987], '(B)': [988], 'limited': [996, 1335, 1379, 3786], 'number': [997, 1277, 1392, 3931], 'small': [1003, 1391], 'careful': [1009], 'analyses': [1010], 'nonrandomized': [1012], 'studies': [1013, 1219, 1376, 1446, 2359, 2682, 2690, 2696, 3762], 'observational': [1015], 'registries.': [1016], 'A': [1017, 1178, 2135, 3431, 4110], 'lower': [1018, 1356, 2080, 2721], '(C)': [1020], 'expert': [1024], 'consensus': [1025], 'primary': [1028], 'recommendation.The': [1032], 'welcomes': [1039], 'feedback': [1040], 'article.': [1050], 'Please': [1051], 'direct': [1052], 'your': [1053], 'comments': [1054], 'c/o': [1059], 'Dawn': [1060], 'Phoubandith,': [1061], 'via': [1067], 'e-mail': [1068], '([email': [1069], 'protected]).Modification': [1070], 'IThe': [1071], 'text': [1072, 1985, 2014, 2835], 'appeared': [1078, 1619, 2016, 2840], 'under': [1079, 2017, 2841], 'heading': [1082, 1625, 2020, 2844], '“Diagnosis”': [1083], 'subheading': [1086, 2025, 2849], '“Influence': [1087], 'Other': [1089], 'Factors': [1090], 'Performance”': [1093], 'has': [1094, 1203, 1490, 2047, 3428, 3808, 4063, 4149], 'extensively': [1096], 'reorganized.': [1097], 'began': [1099], 'page': [1101, 1630, 2032, 2854], '272': [1102], '(second': [1103, 2034], 'column)': [1104], 'guidelines.': [1108, 4140], 'New': [1109, 1124], 'regarding': [1111, 2818], 'ST–heart': [1112], 'rate': [1113, 1146, 1170, 1250, 1271, 2389, 2396, 2449, 2463, 2466, 2484, 2592, 2617, 3176, 3778], 'adjustment': [1115, 1147, 1202], 'during': [1117, 1832, 1995, 2004, 3109, 3860, 3881], 'after': [1119, 1741, 1770, 1818, 1997, 2006, 2452, 2515, 3638], 'reproduced': [1122], 'below.': [1123], 'atrial': [1127], 'repolarization': [1128], 'right': [1130, 1677], 'chest': [1131, 1330, 2830, 3113, 3218, 3656, 3663, 4046, 4075, 4086, 4100, 4121, 4256, 4268, 4286], 'leads': [1132, 1279, 1353, 3933], 'appears': [1133, 2765], 'Internet.ST–Heart': [1140], 'Rate': [1141], 'AdjustmentSeveral': [1142], 'methods': [1143], 'heart': [1145, 1169, 1199, 1249, 1343, 1350, 1536, 1751, 1780, 2232, 2388, 2448, 2462, 2465, 2483, 2591, 2616, 3175, 3210, 3622], 'proposed': [1150], 'increase': [1152, 1197, 2270, 2279, 2289, 2299, 2406], 'diagnostic': [1154, 1225], 'accuracy': [1155, 1494], 'ECG.': [1159], 'maximal': [1161], 'slope': [1162, 1427], 'ST': [1165, 1189, 1442, 1525, 1687, 1879, 1888, 2137, 2213, 2252, 3095, 3977, 4043, 4192], 'segment': [1166], 'relative': [1167, 2631], 'either': [1173, 2376, 3360], 'manually1': [1174], 'computer.2': [1177], 'second': [1179], 'technique,': [1180], 'termed': [1181], 'ST/HR': [1183, 1201, 1357, 1383, 1426, 1461, 1485, 1509, 1552, 1594], 'index,': [1184], 'divides': [1185], 'difference': [1187, 3263, 3301], 'between': [1188, 2681, 3952], 'depression': [1190, 1529, 1880, 1889, 2253, 3937, 3978, 4044], 'at': [1191, 1491, 1620, 2330, 2342, 2352, 2492, 2528, 2538, 2556, 2793, 3091, 3828, 4012], 'peak': [1192, 2460, 3939], 'exercise-induced': [1196, 2251, 3976], 'rate.3,4': [1200], 'subject': [1206], 'several': [1208], 'since': [1210], 'last': [1212, 4058], 'publication': [1213], 'guidelines.5,6': [1216], 'approach': [1223, 1486, 1510], 'include': [1227, 3487], 'Morise’s': [1228], 'report7': [1229], '1358': [1231], 'individuals': [1232, 1454], 'undergoing': [1233, 1647, 1665], '(only': [1236], '152': [1237], 'with': [1238, 1257, 1295, 1301, 1329, 1401, 1460, 1531, 1549, 1556, 1568, 1611, 1650, 1668, 1675, 1699, 1706, 1714, 1723, 1841, 1848, 1905, 1915, 1929, 1945, 1959, 2106, 2125, 2155, 2199, 2403, 2547, 2745, 2757, 2775, 2820, 3028, 3047, 3061, 3093, 3205, 3221, 3332, 3489, 3494, 3556, 3583, 3670, 3672, 3689, 3702, 3742, 3766, 3800, 3824, 3834, 3908, 3934, 3983, 4002, 4066], 'catheterization': [1239, 3603], 'data)': [1240], 'report': [1243, 4272], 'Okin': [1245, 1317], 'et': [1246, 1261, 1318, 1324, 3225, 3229, 3238, 3249, 3258, 3272, 3285, 3293, 4179], 'al8': [1247], 'considering': [1248], 'reserve': [1251], '(238': [1252], 'controls': [1253], '337': [1255], 'coronary': [1258, 1284, 1296, 2567, 2880, 2885, 3209, 3313, 3334, 3724, 3737, 3797, 4108], 'disease).': [1259], 'Viik': [1260, 1323], 'al': [1262, 1319, 1325, 3230, 3239, 3250, 3259, 3273, 3286, 3294], 'considered': [1263, 1326], 'maximum': [1265, 2386, 3169, 3174], 'value': [1266, 1459, 2036, 2227, 2520, 2769, 3842], 'ST-segment': [1269, 1528, 2153, 3936], 'depression/heart': [1270], '(ST/HR)': [1272], 'hysteresis': [1273], 'over': [1274, 2413, 2691, 3386], 'different': [1276, 2217], 'detection': [1282], 'artery': [1285, 2881, 2886], 'disease': [1286, 1297, 1307], '(CAD).9': [1287], 'study': [1289, 1315, 1400, 1411, 2552, 2574, 3893, 3951, 4176], 'population': [1290, 2328], 'consisted': [1291], '127': [1293], '220': [1299], 'low': [1303, 1349, 1452, 2331, 2392, 2643, 2794, 4159, 4283], 'likelihood': [1304, 3032, 3051], 'test.': [1312, 2371, 2672, 3867, 4222], 'Neither': [1313], 'consecutive': [1327, 2577], 'pain,': [1331], 'had': [1334, 1389, 2074, 2088, 2561, 3771, 3957], 'challenge.': [1336], 'Because': [1337, 2717], 'healthy': [1338, 1372], 'relatively': [1341, 1371], 'high': [1342, 1534, 2353, 3031, 3050], 'rates': [1344], 'sick': [1346], 'rates,': [1351], 'index': [1358, 1364, 1429, 1553, 2394], 'normals': [1360], 'higher': [1363], 'sicker': [1366], 'patients,': [1367, 1539, 1992, 2578, 3485, 3608], 'enrollment': [1369], 'presents': [1377], 'challenge': [1380], 'index.': [1384], 'Likewise,': [1385], 'Morise': [1387], 'study7': [1388], 'who': [1395, 1743, 1772, 1797, 1920, 1934, 2423, 2560, 2639, 2750, 3486, 3559, 3586, 3694, 3770, 3856, 3956, 4006, 4157, 4259], 'underwent': [1396, 4007, 4216], 'angiography.': [1397], 'only': [1399, 2102, 4038], 'neither': [1402], 'limitations': [1405], 'QUEXTA.10': [1407], 'multicenter': [1410], 'followed': [1412, 2056], 'protocol': [1414, 3659, 4271], 'reduce': [1416], 'workup': [1417], 'bias': [1418], 'analyzed': [1421], 'independent': [1423, 2600, 3919], 'statisticians.': [1424], 'found': [1432, 3760], 'accurate': [1436], 'than': [1437, 1682, 1874, 1910, 2068, 2082, 2272, 2335, 2473, 2522, 2946, 3015, 3021, 3056, 3074, 3087, 3098, 3103, 3131, 3139, 3143, 3480], 'simple': [1438], 'measurement': [1439, 4198], 'segment.': [1443, 3725], 'Although': [1444, 1499], 'asymptomatic': [1448, 1538], '(and': [1449], 'therefore': [1450], 'very': [1451, 1533], 'likelihood)': [1453], 'demonstrated': [1456, 2441], 'additional': [1457, 3854], 'prognostic': [1458, 2042, 2115, 2141, 2179, 2363, 2443, 2666, 3841], 'adjustment,': [1462], 'directly': [1467], 'applicable': [1468], 'issue': [1471], 'diagnosis': [1473, 3184, 3196], 'symptomatic': [1475, 1488, 2629], 'patients.11,12': [1476], 'Nevertheless,': [1477], 'one': [1478, 3367, 3875], 'could': [1479, 1511, 4026], 'take': [1480], 'perspective': [1482], 'least': [1492, 2970], 'equivalent': [1493, 2209], 'standard': [1497, 1558, 2670, 2732, 3682], 'approach.': [1498], 'yet': [1501], 'validated,': [1502], 'situations': [1505], 'prove': [1512], 'useful,': [1513], 'such': [1514, 2931, 4041, 4285], 'rendering': [1517], 'judgment': [1519], 'concerning': [1520], 'certain': [1521], 'borderline': [1522], 'equivocal': [1524], 'responses,': [1526], 'eg,': [1527], 'associated': [1530, 1548, 2105, 2124, 2402, 2546], 'rate.In': [1537], 'MRFIT,': [1541], 'significant': [1542, 1707, 1724, 1809, 2664, 3711, 3720], 'concentration': [1543], 'cardiac': [1545, 1575, 1800, 1812, 2126, 2790, 2798, 2912, 3123, 3468, 3602, 4019, 4053], 'risk': [1546, 1581, 1607, 2332, 2344, 2354, 2409, 2626, 2644, 2772, 2795, 3433, 3985, 4017, 4095, 4160], 'abnormal': [1551, 1557, 2447, 2482, 2590, 2615], 'but': [1554, 2981, 2992, 3141, 3643, 3849, 4048], 'test': [1560, 1588, 2636, 2740, 3678, 3823, 3826, 3852, 4011], 'criteria': [1561], 'judged': [1563], 'computer': [1565], 'interpretation.12': [1566], 'Compared': [1567], 'usual': [1572], 'care': [1573, 3538], 'group,': [1574], 'events': [1576, 2127, 2914, 3382, 3859, 3873, 3879, 4020, 4227], 'reduced': [1578], 'factor': [1582], 'modification': [1583], 'group': [1584], 'positive': [1590, 2136, 3972], 'according': [1591], 'index.13Modification': [1595], 'IIThese': [1596], 'revised': [1597, 1984, 2806, 3447], 'top': [1600], 'incorporate': [1603, 2814], 'stratification': [1608, 2627, 3434, 4096], 'unstable': [1612, 1731, 1760, 1791, 1973, 2821, 2916, 3557, 3584, 3703, 3753, 3768, 3835, 3909, 3944, 4004], 'angina.': [1613], 'originally': [1618, 2839], 'beginning': [1622, 2030, 2852], '“Risk': [1627, 2021, 2845], 'Assessment”': [1628], '274': [1631], '(first': [1632, 2856], 'column).Modification': [1633], 'II1997': [1634], 'Recommendation2002': [1638], 'RecommendationClass': [1642], 'IClass': [1643], 'I': [1644, 3129, 4001], '1.': [1645, 1663, 1789, 1839, 1846, 1943, 1957], 'initial': [1648, 1666, 1799, 3440, 3464], 'evaluation': [1649, 1667, 3552, 4214], 'suspected': [1651, 1669, 1700, 1715], 'known': [1653, 1671, 1702, 1717], 'CAD.': [1654, 3712], 'exceptions': [1656, 1690], 'noted': [1658, 1692], 'below': [1659, 1693, 2225, 2311], 'Class': [1661, 1695], 'IIb.': [1662, 1696], 'CAD,': [1672, 1718, 2884], 'including': [1673], 'those': [1674, 3213], 'complete': [1676], 'bundle-branch': [1678, 1893, 1898, 2902], 'block': [1679, 1894, 1899, 3500], '1': [1683, 1875, 1882, 2276, 2523, 2539, 2971, 2984, 3499, 3502, 3829], 'mm': [1684, 1876, 1883, 2274, 2284, 2294, 2304], 'resting': [1686, 1851, 1878, 1887, 2226, 2748, 3692, 4203], 'depression.': [1688], '2.': [1697, 1712, 1913, 1927, 1971], 'previously': [1704, 1719], 'evaluated': [1705, 3561, 3648, 4184], 'status.': [1711, 1728], 'evaluated,': [1720], 'presenting': [1722, 3340], '3.': [1729], 'Low-risk': [1730, 3484], 'angina': [1732, 1761, 1792, 1974, 2122, 2822, 2917, 3041, 3054, 3316, 3493, 3558, 3585, 3704, 3769, 3836, 3910, 3945, 4005], 'Table': [1735, 1764, 1795, 1977, 2812, 2837, 3448, 4080, 4275], '17)': [1736, 1765, 1796], '8': [1737, 3629], '12': [1739, 1816, 2477, 3631], 'hours': [1740, 1817, 3575, 3781, 4189], 'presentation': [1742, 1771], 'free': [1746, 1775, 3617], 'active': [1748, 1777, 3619], 'ischemic': [1749, 1778, 2913, 3620, 3935, 4039], 'failure': [1752, 1781, 2233, 2377, 3623], 'symptoms.': [1753, 1782], '(Level': [1754, 1783, 1979], 'Evidence:': [1756, 1785, 1835, 1981], 'B)': [1757], '4.': [1758], 'Intermediate-risk': [1759, 1790, 3633], '2': [1766, 2195, 2216, 2286, 2468, 3045, 3639, 3845], '3': [1768, 2529, 3641, 3761], 'days': [1769, 4013], 'B)Class': [1786, 1836], 'IIaClass': [1787], 'IIa': [1788], 'markers': [1801, 1813, 4208], 'normal,': [1804], 'repeat': [1806], 'without': [1808, 3718, 4206], 'change,': [1810], '6': [1814, 2493, 3392, 4024], 'onset': [1820], 'symptoms': [1822, 3495, 3624], 'no': [1827, 2656, 3729, 4225], 'other': [1828, 2366, 2633], 'ischemia': [1831], 'observation.(Level': [1833], 'IIbClass': [1837], 'IIb': [1838], 'following': [1843, 1850, 2974, 2998], 'abnormalities': [1845, 1853], '•': [1854, 1858, 1862, 1867, 1872, 1881, 1890, 1895], 'Pre-excitation': [1855, 1859], '(Wolff-Parkinson-White)': [1856, 1860], 'syndrome': [1857, 1861, 3314, 3798], 'Electronically': [1863, 1868], 'paced': [1864, 1869], 'ventricular': [1865, 1870, 3121], 'rhythm': [1866, 1871], 'Greater': [1873], 'Complete': [1891, 1896], 'left': [1892, 1897], 'any': [1901, 2995, 3723], 'interventricular': [1902], 'conduction': [1903], 'defect': [1904], 'QRS': [1907], 'duration': [1908, 2205], 'greater': [1909, 2067, 2271, 2521, 3097, 3102, 3130, 3138], '120': [1911], 'ms': [1912], 'stable': [1917, 1931, 3374, 3673], 'course': [1919, 1933], 'undergo': [1921, 1935], 'periodic': [1922, 1936], 'monitoring': [1923, 1937], 'guide': [1925, 1939], 'treatment.': [1926], 'treatment.Class': [1940], 'IIIClass': [1941], 'severe': [1946, 1960, 2548], 'comorbidity': [1947, 1961, 2076], 'likely': [1948, 1962, 3069], 'limit': [1950, 1964], 'life': [1951, 1965, 3327], 'expectancy': [1952, 1966], 'candidacy': [1954, 1968], 'revascularization.': [1956, 1970], 'High-risk': [1972], '17).': [1978], 'C)Modification': [1982], 'IIIThis': [1983], 'elderly': [1991, 2045, 2064], 'heart-rate': [1993], 'responses': [1994, 2003], 'exercise,': [1998, 2516], 'systolic': [2000, 2222, 2259, 2265, 2313, 2511, 2525, 2535], 'blood': [2001, 2223, 2260, 2266, 2315, 2512, 2526, 2536, 2621], 'pressure': [2002, 2224, 2261, 2513, 2527, 2537, 2622], 'exercise.': [2007, 2754], 'It': [2008, 3336], 'replaces': [2009], 'Stratification”': [2022, 2846], '“Nonacute': [2026], 'Disease”': [2029], '278': [2033], 'column).The': [2035], 'treadmill': [2039, 2103, 2202, 2433, 2597, 2635, 2733, 2760, 2778, 2827, 3677], 'assessment': [2043], 'subjects': [2046], 'described': [2049], 'Olmstead': [2052], 'County,': [2053], 'Minnesota,': [2054], 'cohort': [2055], 'Mayo': [2059], 'Clinic.14': [2060], 'As': [2061], 'expected,': [2062], '(aged': [2066], 'equal': [2070, 2475], '65': [2072], 'years)': [2073], 'achieved': [2078], 'workload': [2081, 2119, 3941], 'their': [2083, 3783], 'younger': [2084], 'counterparts.': [2085], 'They': [2086, 2833], 'also': [2087, 2440, 4049], 'significantly': [2090], 'worse': [2091], 'unadjusted': [2092], 'survival.': [2093], 'Workload': [2094], 'expressed': [2095], 'metabolic': [2097], 'equivalents': [2098], '(METs)': [2099], 'variable': [2104], 'all-cause': [2107, 2411, 2490], 'mortality': [2108, 2412, 2491], 'groups': [2111, 3458, 3982], '(adjusting': [2112], 'variables),': [2116], 'whereas': [2117, 3529], '(death': [2128], 'plus': [2129], 'myocardial': [2130, 2762, 2785, 2877, 3180, 3319, 3363, 3776, 3914], 'infarction)': [2131, 3320], 'groups.': [2134], 'response': [2138, 2514, 2623], 'older': [2144, 3073, 3086], 'tested': [2147, 3637, 4242], 'binary': [2150], 'variable.': [2151], 'Quantitative': [2152], 'deviation': [2154], 'apparently': [2158], 'cohort,': [2163], 'Duke': [2166, 2201, 2596], 'Treadmill': [2167], 'Score': [2168], 'computed': [2171], 'study.Morrow': [2174], 'colleagues15': [2176], 'developed': [2177], 'score': [2180, 2193, 2203, 2241, 2262, 2598, 2779], 'using': [2181], '2546': [2184], 'Long': [2187, 2323], 'Beach': [2188, 2324], 'Veterans': [2189, 2325], 'Administration': [2190, 2326], 'Hospital.': [2191], 'includes': [2194], 'variables': [2196, 2218, 4035], 'common': [2198], '(exercise': [2204], 'MET': [2208, 2399], 'millimeters': [2211, 2255], 'changes)': [2214], '(drop': [2219], 'history': [2229, 3207, 3354, 4165], 'congestive': [2231], '[CHF]': [2234], 'use': [2236, 2825, 3791, 3897, 4068], 'digoxin': [2238], '[Dig]).': [2239], 'calculated': [2243], 'follows:5': [2245], '×': [2246], '(CHF/Dig': [2247], '[yes=1;': [2248], 'no=0])': [2249], '+': [2250, 2256], '−': [2263], 'METs,where': [2264], 'pressure=0': [2267], '40': [2273, 2283], 'Hg,': [2275, 2285, 2295, 2305], '31': [2281], '21': [2291], '30': [2293], '4': [2296, 3390], '0': [2301], '11': [2303], '5': [2307, 4014], 'reduction': [2310], 'standing': [2312], 'preexercise': [2314], 'pressure.': [2316], 'score,': [2319, 2761], '77%': [2320], 'Hospital': [2327], '(with': [2333], '2%': [2336], 'average': [2337], 'annual': [2338, 2346, 2356], 'mortality),': [2339], '18%': [2340], 'moderate': [2343, 3029, 3048], '(average': [2345, 2355], 'mortality,': [2347, 2357], '7%),': [2348], '6%': [2350], '15%).Several': [2358], 'highlighted': [2361], 'importance': [2364, 2444], 'parameters': [2367, 4040, 4050], 'Chronotropic': [2372], 'incompetence,': [2373, 2614], 'defined': [2374, 2517], 'achieve': [2379], '80%': [2380], '85%': [2382], 'age-predicted': [2385, 3173], 'chronotropic': [2393, 2613], '(heart': [2395], 'adjusted': [2397], 'level),': [2400], '84%': [2405], '2-year': [2415], 'follow-up': [2416, 3189], '1877': [2418], 'men': [2419, 2744, 3906], '1076': [2421], 'women': [2422, 3997], 'Cleveland': [2428, 2436, 2558, 2585], 'Clinic': [2429, 2437, 2559, 2586], 'symptom-limited': [2431, 2563, 3168, 3816, 3900, 4009, 4218], 'thallium': [2432, 2500], 'testing.16,17': [2434], 'investigators': [2438, 2587], 'recovery': [2450, 2485, 2532, 2593], 'pattern': [2451], 'testing.': [2454], 'Defined': [2455], 'measured': [2467], 'minutes': [2469, 2530], 'later': [2470], 'beats': [2478], 'per': [2479], 'minute,': [2480], 'strongly': [2487], 'predictive': [2488, 3254, 3256, 3283, 3291], 'years': [2494], '2428': [2496], 'testing.18': [2502], 'Similar': [2503], 'trends': [2504], 'suggested': [2507], 'delayed': [2510, 2620], 'divided': [2533], 'minute': [2540], 'recovery.': [2542], 'finding': [2544], '493': [2554], 'angiography': [2568], '(within': [2569], '90': [2570], 'days).19': [2571], 'In': [2572, 2673, 2755, 3566, 3578, 3606, 3667, 3868, 3995, 4141, 4174], '9454': [2576], 'most': [2579, 2737, 3068, 3567, 4142], 'whom': [2581], 'asymptomatic,': [2583], 'reported': [2588], 'predictors': [2601, 3920], 'mortality.20': [2603], 'Further': [2604], 'work': [2605], 'needed': [2607], 'define': [2609, 3745], 'role': [2611, 3396], 'recovery,': [2618], 'well-validated': [2634], 'parameters.In': [2637], 'classified': [2641], 'information,': [2653], 'compelling': [2657], 'imaging': [2661, 2689, 2701, 2764], 'modality': [2662], 'adds': [2663], 'information': [2667], 'regard,': [2675], 'distinction': [2677], 'should': [2678, 3544, 3570, 3597, 3679], 'made': [2680], 'show': [2684], 'statistical': [2686], 'advantage': [2687], 'alone': [2694], 'demonstrate': [2698], 'would': [2703, 3857], 'practice': [2705], '(eg,': [2706, 3125, 3135], 'shifting': [2708], 'moderate-': [2711], 'low-': [2713, 3579], 'high-risk': [2715, 2979, 3457, 3530, 4207], 'categories).': [2716], 'its': [2719, 2727], 'simplicity,': [2720], 'cost,': [2722], 'widespread': [2724], 'familiarity': [2725], 'performance': [2728], 'interpretation,': [2730], 'reasonable': [2738], 'select': [2742], 'able': [2752], 'intermediate-risk': [2759, 2777, 2990, 3518, 3581], 'perfusion': [2763, 2786], 'further': [2771], 'stratification.21': [2773], 'near-normal': [2783], 'images': [2787], 'size': [2791], 'future': [2797], 'death': [2799, 2909, 3361, 3774, 3987], 'managed': [2803], 'medically.22Modification': [2804], 'IVThis': [2805], 'revisedTable': [2808], '17,': [2809], '17a': [2813], 'pain': [2831, 3219, 3657, 3664, 4047, 4076, 4087, 4101, 4122, 4257, 4269, 4287], 'centers.': [2832], 'replace': [2834], '17that': [2838], '“Unstable': [2850], 'Angina,”': [2851], '280': [2855], 'column).Revised': [2857], 'TABLE': [2858], '17.': [2859, 3449], 'Short-Term': [2860], 'Risk': [2861], 'Death': [2863], 'Nonfatal': [2865], 'Unstable': [2871, 2963, 3421], 'AnginaHigh': [2872], 'RiskIntermediate': [2873], 'RiskLow': [2874], 'RiskMI': [2875], 'infarction;': [2878], 'CABG,': [2879], 'bypass': [2882], 'graft;': [2883], 'disease;': [2887], 'NTG,': [2888], 'nitroglycerin;': [2889], 'CCSC,': [2890], 'Canadian': [2891], 'Cardiovascular': [2892], 'Society': [2893], 'Classification;': [2894], 'MR,': [2895], 'mitral': [2896], 'regurgitation;': [2897], 'ECG,': [2898, 3466, 4170], 'electrocardiography;': [2899], 'BBB,': [2901], 'block.Estimation': [2903], 'short-term': [2906], 'risks': [2907], 'nonfatal': [2911], 'complex': [2920], 'multivariable': [2921, 3926], 'problem': [2922], 'cannot': [2924], 'specified': [2927], 'this.': [2933], 'Therefore,': [2934], 'meant': [2938, 3475], 'offer': [2940], 'guidance': [2942], 'illustration': [2944], 'rather': [2945, 3479], 'rigid': [2947], 'algorithms.': [2948], 'Adapted': [2949], 'Agency': [2951], 'Health': [2953], 'Care': [2954], 'Policy': [2955], 'Research': [2957, 3885], 'Clinical': [2958], '10,': [2962], 'Angina:': [2964], 'Diagnosis': [2965], 'Management,': [2967], 'May': [2968], '1994.FeatureAt': [2969], 'features': [2975], 'must': [2976, 2982], 'present:No': [2978], 'feature': [2980, 2991, 3341], 'following:No': [2987], 'high-': [2988], 'features:HistoryPrior': [2999], 'MI,': [3000], 'peripheral': [3001], 'cerebrovascular': [3003], 'disease,': [3004], 'CABG': [3006], 'prior': [3008], 'aspirin': [3009], 'useCharacter': [3010], 'painProlonged': [3012, 3019], 'ongoing': [3013], '(greater': [3014, 3020], '20': [3016, 3022, 3057], 'minutes)': [3017, 3023, 3058], 'rest': [3018, 3024, 3062, 3092], 'angina,': [3025, 3674], 'resolved,': [3027], 'CADNew-onset': [3034], 'progressive': [3036, 3492], 'CCSC': [3037], 'IV': [3040], 'past': [3044], 'weeks': [3046], 'CADRest': [3053], '(less': [3055], 'relieved': [3060], 'sublingual': [3064], 'NTG)Clinical': [3065], 'findingsPulmonary': [3066], 'edema,': [3067], 'related': [3070], 'ischemiaAge': [3072], '70': [3075, 3202], 'yearsNew': [3076], 'worsening': [3078], 'MR': [3079], 'murmurS3': [3080], 'new/worsening': [3082], 'ralesHypotension,': [3083], 'bradycardia,': [3084], 'tachycardiaAge': [3085], '75': [3088], 'yearsECG': [3089], 'findingsAngina': [3090], 'transient': [3094], '0.05': [3099], 'mVT-wave': [3100], 'inversions': [3101], '0.2': [3104], 'mVNormal': [3105], 'unchanged': [3107], 'episode': [3111], 'discomfortBBB,': [3114], 'presumed': [3117], 'newPathological': [3118], 'Q': [3119], 'wavesSustained': [3120], 'tachycardiaBiochemical': [3122], 'markersElevated': [3124], 'troponin': [3126, 3136, 3960, 3973], 'T': [3127, 3137, 3961, 3974], '0.1': [3132, 3144], 'mg/mL)Slightly': [3133], 'elevated': [3134], '0.01': [3140], 'mg/mL)NormalTABLE': [3145], '17A.': [3146], 'Studies': [3149], 'Chest': [3155], 'Pain': [3156, 4055], 'CentersGroup': [3157], '(year)ReferenceNo.': [3158], 'SubjectsFollow-Up': [3160], 'PeriodExercise': [3161], 'ECGAdverse': [3162], 'Events*%': [3163], 'PrevalenceClinical': [3165], 'OutcomeSLM': [3166], 'end': [3170, 3177], 'point;': [3171], 'APMHR,': [3172], 'point.*Death': [3178], 'infarction.†With': [3181], 'respect': [3182, 3193], 'admitted,': [3186], '30-day': [3188], 'patients.‡With': [3192], 'reference': [3195, 3278], 'admission': [3198], 'patients.§Included': [3201], '(25%)': [3204], 'disease.¶Comparison': [3211], 'admitted': [3214, 3270, 3276, 3307, 3534], 'hospital': [3216, 3527], 'vs': [3217, 3247, 3269, 3306], 'center.Reprinted': [3220], 'permission': [3222], 'Stein': [3224], 'al,': [3226], 'Circulation.': [3227], '2000;102:1463–1467.25Tsakonis': [3228], '(1991)31286.1': [3231], 'moModified': [3232, 3288], 'Bruce': [3233, 4219], '(SLM)00Exercise': [3234], 'safeKerns': [3237], '(1993)32326': [3240], 'moBruce': [3241], '(APMHR)00Exercise': [3242], 'safeReduced': [3245], 'cost': [3246, 3268, 3305], 'admissionGibler': [3248], '(1995)29101030': [3251], 'dBruce': [3252], '(SLM)05Sensitivity=29%Specificity=99.4%Positive': [3253], 'value=44%†Negative': [3255], 'value=98.7%†Gomez': [3257], '(1996)3350,': [3260], 'plusNoneCornell': [3261], '(SLM)06No': [3262], 'outcome50': [3266], 'controlsReduced': [3267], 'controlZalenski': [3271], '(1998)34317None;': [3274], 'diagnosisModified': [3279], 'Bruce09.5Sensitivity=90%': [3280], 'Specificity=50%‡': [3281], 'Negative': [3282], 'value=98%‡Polanczyk': [3284], '(1998)35276§6': [3287], 'Bruce025Sensitivity=73%Specificity': [3289], '74%Negative': [3290], 'value=98%Farkouh': [3292], '(1998)304246': [3295], 'moNot': [3296], 'specified0Intermediate-risk': [3297], 'studiedNo': [3300], 'outcomes¶Reduced': [3304], 'controlPatients': [3308], 'Acute': [3310], 'SyndromeAcute': [3312], '(unstable': [3315], 'acute': [3318, 3323, 3407, 3796, 4107], 'represents': [3321], 'phase': [3324, 3347, 3375], 'cycle': [3328], 'patient': [3331, 3807], 'chronic': [3333, 3373], 'disease.': [3335, 3351, 4109], 'interrupt': [3344], 'quiescent': [3346], 'clinically': [3349], 'manifested': [3350], 'natural': [3353], 'ACS': [3356, 3403], 'involves': [3357], 'progression': [3358], 'infarction': [3364, 3777, 3915], 'hand': [3368], 'return': [3370], 'other.': [3380], 'These': [3381, 4244], 'typically': [3383, 3510, 3533], 'play': [3384], 'out': [3385], 'period': [3388, 3862], 'weeks.': [3393], 'Thus,': [3394], 'timing': [3398], 'relates': [3404], 'convalescent': [3409], 'period.The': [3410], 'Management': [3417], 'Angina': [3422], 'Non–ST-Segment': [3424], 'Elevation': [3425], 'published.23': [3430], 'algorithm': [3435], 'selecting': [3438], 'management': [3441, 3658, 4098], 'strategy': [3442], 'seen': [3444], 'separated': [3452], 'into': [3453, 3981], 'low-,': [3454], 'intermediate-,': [3455], 'based': [3459], 'history,': [3461], 'physical': [3462, 4113, 4167], 'examination,': [3463, 4168, 4187], '12-lead': [3465, 4169, 4195], 'markers.': [3469, 4173], '(Note': [3470], 'illustrative': [3478], 'comprehensive': [3481], 'definitive.)': [3483], 'new-onset': [3490], 'provoked': [3496], 'walking': [3498], 'flight': [3503], 'stairs,': [3505], 'scheme': [3508], 'treated': [3512], 'outpatient': [3515, 3564], 'basis.': [3516, 3565], 'Most': [3517], 'cared': [3522], 'monitored': [3526], 'bed,': [3528], 'intensive': [3537], 'unit.Exercise': [3539], 'pharmacological': [3541, 3594], 'stress': [3542, 3595, 3685, 4010], 'generally': [3545, 3598, 4247], 'integral': [3548], 'part': [3549, 3651, 4265], 'low-risk': [3554, 3607], 'cases,': [3568], 'performed': [3572, 3600, 3612, 3827], 'within': [3573, 3779], '72': [3574], 'presentation.': [3577], 'hospitalized': [3589], 'evaluation,': [3591], 'unless': [3601], 'indicated.': [3605], 'minimum': [3627], 'hours.23': [3632], 'days,': [3642], 'selected': [3644], 'earlier': [3649, 3851, 3872], 'carefully': [3654], 'constructed': [3655], 'section': [3661], 'centers': [3665, 4077, 4123, 4126], 'below).': [3666], 'general,': [3668], 'mode': [3683], 'taking': [3697], 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'represented': [3874], 'half': [3876], 'occurring': [3880], 'first': [3883], 'year.The': [3884], 'Instability': [3887], '(RISC)': [3892], 'group27': [3894], 'examined': [3895], 'bicycle': [3901], '740': [3905], 'admitzted': [3907], '(51%)': [3911], '(49%).': [3916], '1-year': [3922], 'infarction-free': [3923], 'survival': [3924], 'regression': [3927], 'analysis': [3928], 'achieved.In': [3942], '766': [3943], 'enrolled': [3947, 3998], 'FRISC': [3950, 4000], '1992': [3953], '1994': [3955], 'test,': [3967], 'combination': [3969], 'stratified': [3979, 4028], 'MI': [3989], 'ranging': [3990], '1%': [3992, 4030], '20%.28': [3994], '395': [3996], '8,': [4016], 'months': [4025], '19%.': [4032], 'Important': [4033], 'included': [4036], 'workload.Chest': [4054], 'CentersOver': [4056], 'decade,': [4059], 'increasing': [4061], 'gained': [4065], 'emergency': [4073], 'department': [4074], '17a).25': [4081, 4276], 'goal': [4083], 'center': [4088, 4270], 'provide': [4091], 'rapid': [4092], 'efficient': 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2023, 'cited_by_count': 34}, {'year': 2022, 'cited_by_count': 43}, {'year': 2021, 'cited_by_count': 60}, {'year': 2020, 'cited_by_count': 73}, {'year': 2019, 'cited_by_count': 66}, {'year': 2018, 'cited_by_count': 74}, {'year': 2017, 'cited_by_count': 90}, {'year': 2016, 'cited_by_count': 116}, {'year': 2015, 'cited_by_count': 126}, {'year': 2014, 'cited_by_count': 148}, {'year': 2013, 'cited_by_count': 159}, {'year': 2012, 'cited_by_count': 185}], 'updated_date': '2024-12-17T06:53:33.105117', 'created_date': '2019-02-21'}
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