Editing Cardiac stress test (section)

== Diagnostic value ==
The common approach for stress testing recommended by the American College of Cardiology<ref>{{Cite journal |last1=Gibbons |first1=Raymond J. |last2=Balady |first2=Gary J. |last3=Beasley |first3=John W. |last4=Faafp |last5=Bricker |first5=J. Timothy |last6=Duvernoy |first6=Wolf F. C. |last7=Froelicher |first7=Victor F. |last8=Mark |first8=Daniel B. |last9=Marwick |first9=Thomas H. |last10=McCallister |first10=Ben D. |last11=Thompson |first11=Paul Davis |last12=Facsm |last13=Winters |first13=William L. |last14=Yanowitz |first14=Frank G. |date=July 1997 |title=ACC/AHA Guidelines for Exercise Testing: Executive Summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) |url=https://www.ahajournals.org/doi/10.1161/01.CIR.96.1.345 |journal=Circulation |language=en |volume=96 |issue=1 |pages=345–354 |doi=10.1161/01.CIR.96.1.345 |pmid=9236456 |issn=0009-7322|url-access=subscription }}</ref><ref>{{Cite web |date=2020-10-27 |title=Why You May Not Need a Stress Test |url=https://health.clevelandclinic.org/do-you-really-need-a-stress-test-theyre-not-for-everyone/ |access-date=2023-11-08 |website=Cleveland Clinic |language=en-US}}</ref> and the American Heart Association<ref>{{Cite web |title=Exercise Stress Test |url=https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-test |access-date=2023-11-08 |website=www.heart.org |language=en}}</ref> involves several methods to assess cardiac health. These methods provide information for diagnosing and managing heart-related conditions. Two primary stress tests utilized are a treadmill test using [[ECG]]/[[Cardiac electrophysiology|electrophysiology]] metrics and nuclear testing, each have unique sensitivity and specificity values.

The treadmill test, employing the modified [[Bruce protocol]],<ref>{{Cite web |title=Stress Test: Purpose, Procedure, Risks and Results |url=https://my.clevelandclinic.org/health/diagnostics/16984-exercise-stress-test |access-date=2023-11-08 |website=Cleveland Clinic |language=en}}</ref> demonstrates a sensitivity range of around 73-90% and a specificity range of around 50-74%. Sensitivity refers to the percentage of individuals with the condition correctly identified by the test, while specificity denotes the percentage of individuals without the condition correctly identified as not having it.<ref>{{Citation |last1=Vilcant |first1=Viliane |title=Treadmill Stress Testing |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK499903/ |work=StatPearls |access-date=2023-11-08 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29763078 |last2=Zeltser |first2=Roman}}</ref> The nuclear stress test exhibits a sensitivity of 81% and a specificity ranging from 85 to 95%.<ref>{{Cite web |last=Morgenstern |first=Justin |date=2019-03-13 |title=Stress Tests Part 3: Stress test accuracy |url=https://first10em.com/stress-test-accuracy/ |access-date=2023-11-08 |website=First10EM |language=en-US}}</ref>

To arrive at the patient's post test likelihood of disease, the interpretation of the stress test result necessitates the integration of the patient's pretest likelihood with the test's sensitivity and specificity. This method, initially introduced by Diamond and Forrester in the 1970s, provides an estimate of the patient's post-test likelihood of disease.<ref>{{Cite journal |last=Darrow |first=Mark D. |date=1999-01-15 |title=Ordering and Understanding the Exercise Stress Test |url=https://www.aafp.org/pubs/afp/issues/1999/0115/p401.html |journal=American Family Physician |language=en-US |volume=59 |issue=2 |pages=401–410|pmid=9930131 }}</ref><ref>{{Cite journal |last1=Versteylen |first1=Mathijs O. |last2=Joosen |first2=Ivo A. |last3=Shaw |first3=Leslee J. |last4=Narula |first4=Jagat |last5=Hofstra |first5=Leonard |date=2011 |title=Comparison of Framingham, PROCAM, SCORE, and Diamond Forrester to predict coronary atherosclerosis and cardiovascular events |journal=Journal of Nuclear Cardiology |volume=18 |issue=5 |pages=904–911 |doi=10.1007/s12350-011-9425-5 |issn=1071-3581 |pmc=3175044 |pmid=21769703}}</ref> Stress tests have limitations in assessing the significance and nature of cardiac problems, they should be seen in context - as an initial assessment that can lead to a number of other diagnostic approaches in the broader management of cardiac diseases.<ref>{{Cite journal |last1=Bilal |first1=Muhammad |last2=Haseeb |first2=Abdul |last3=Arshad |first3=Mohammad H |last4=Jaliawala |first4=Altamash A |last5=Farooqui |first5=Iman |last6=Minhas |first6=Amna |last7=Hussaini |first7=Ahmedullah |last8=Khan |first8=Arsalan A |last9=Ahmad |first9=Sharjeel |last10=Saleem |first10=Zainab |last11=Awan |first11=Ozair |last12=Sabahat |first12=Noor Us |last13=Ayaz |first13=Araib |last14=Rizwan |first14=Haania |title=Frequency and Determinants of Inappropriate Use of Treadmill Stress Test for Coronary Artery Disease |journal=Cureus |date=2018 |volume=10 |issue=1 |pages=e2101 |doi=10.7759/cureus.2101 |doi-access=free |issn=2168-8184 |pmc=5898845 |pmid=29662724}}</ref>

According to data from the US [[Centers for Disease Control and Prevention]] (CDC) common first systems of coronary artery disease is a heart attack. According to the American Heart Association, a significant percentage of individuals, approximately 65% of men and 47% of women, present with a heart attack or sudden cardiac arrest as their first symptom of cardiovascular disease. Consequently, stress tests performed shortly before these events may not be highly relevant for predicting infarction in the majority of individuals tested.<ref>{{Cite web |last=CDC |date=2021-07-19 |title=Coronary Artery Disease {{!}} cdc.gov |url=https://www.cdc.gov/heartdisease/coronary_ad.htm |access-date=2023-11-10 |website=Centers for Disease Control and Prevention |language=en-us}}</ref><ref>{{Cite web |title=Exercise Stress Test |url=https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/exercise-stress-test |access-date=2023-11-10 |website=www.heart.org |language=en}}</ref>