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Use of the Duke treadmill score — which considers exercise duration, ST-segment change, and presence of anginal pain — has improved the predictive value and reproducibility of exercise test interpretation. The score’s utility and reliability as a prognostic tool have been validated repeatedly, although its specificity is low.
Researchers at the Cleveland Clinic assessed whether adding two more exercise-test characteristics — heart rate recovery and ventricular ectopy during recovery — to the Duke score would improve identification of low-risk patients. They derived a nomogram for predicting all-cause mortality in 33,000 patients and validated the model in 5800 patients; all patients in both groups had normal electrocardiograms and suspected …