Diagnostic value of stress testing in the elderly

The exercise tests performed by 197 patients aged 65 years or more (mean age 68·8) have been reviewed, including 43 healthy subjects, 20 with high blood pressure, 10 with mitral valve disease and '125 with demonstrated coronary artery disease. All tests were done on an electrical cycloergometer, with load increases of 30 W every 3mm. Eighty-four (42·6%) achieved at least 85% of their maximal predicted heart rate. The reasons for non-achievement of this heart rate were limitation by symptoms (30·2%) betablocker therapy (25·8), exhaustion (20·2%), pain in lower extremities (14%) and non-adaptation to cycloergometer (10%). The maximum load achieved and the duration of exercise were significantly lower in mitral and coronary patients. Functional aerobic capacity was decreased in coronary and mitral patients. The VO2 max was directly determined in 45 patients. Mean values (ml kg−1 min−1) were 33·3±3·5 in normals, 15·4±6·2 in coronary and 15·8±4·1 in mitral patients. The incidence of arrythmias during exercise was higher in hypertensive (55%) than in mitral (40%), normal (33·3%) and coronary patients (32·8%). In 5 patients the test had to be interrupted because of ventricular tachycardia. The yield of ST depression (>0·1 mV) or elevation (>0·2 mV) in the diagnosis of coronary artery disease was 0·62 sensitivity and 0·93 specificity We conclude that stress test is a useful tool in cardiovascular diagnosis among older patients. Its value, however, must not be limited only to ECG alterations, because there are other criteria (heart rate achieved, blood pressure response, functional aerobic capacity) that can be of aid in the diagnosis, prognosis and therapy.