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Abstract Objective To analyze the value of exercise stress test (EST) and related parameters on diagnosing coronary heart disease (CHD), and to explore the influence of individual factors [such as age, sex and body mass index(BMI)] on its diagnostic accuracy. Methods We selected 439 patients who had performed treadmill or bicycle exercise test and coronary angiography (CAG). There were 318 CAG positive patients and 121 negative cases among those patients. The sensitivity and specificity of their EST results were observed. All the enrolled patients were grouped according to age, sex, BMI, the number of lesioned vessels, the lesioned vessels whether including the left main artery (LM) and(or) the proximal branch of the left anterior descending artery (LAD1), and the presence or absence of ventricular arrhythmias. The reference value of EST parameters on the definite diagnosis of CHD was analyzed in each group.Results The sensitivity and specificity of EST in diagnosing CHD is separately 81.22% and 34.71%. The true positive rate of the multibranch coronary artery lesion group is significantly higher than that of the singlebranch vascular lesion group (88.12% vs. 73.96%, P=0.011), however its false negative rate is lower than that of the singlebranch vascular lesion group (11.88% vs. 26.04%, P=0.011). The true positive rate of the LM and(or) LAD1 lesion group does not vary significantly from that of the nonLM and(or) LAD1 lesion group (76.92% vs. 8602%, P=0.103). In the EST true positive group, the peak heart rate (HR) during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period are all lower than those in the false positive group (P＜0.05). Among the true positive cases, the peak HR during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period of the singlebranch vascular lesion group are all higher than those of the multibranch coronary artery lesion group (P＜0.05). The incidence of ventricular arrhythmias of the true positive group is significantly higher than that of the false positive group (63.06% vs. 18.02%, P=0.048) and the false negative group (63.06% vs. 7.21%, P=0.046). Conclusion EST has some diagnostic value for CHD. For the elderly overweight males with abnormal peak HR during exercise, attainment rate of target HR, and 1 and 2 min HR during the recovery period, and with ventricular arrhythmias, positive EST results suggest further CAG examination. For the patients with high suspicion of CHD and negative EST results, the related individual factors should be comprehensive analyzed.
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