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Most guidelines do not recommend routine stress testing for asymptomatic patients with stable coronary heart disease. In the prospective observational Heart and Soul Study, researchers assessed the prognostic value of stress testing in more than 900 outpatients with stable CHD who were followed for a mean of 3.9 years.
On initial testing, 24% of patients exhibited ischemia on exercise stress echocardiography (defined as wall-motion abnormalities that developed with exercise). Only a minority (18%) of patients with ischemia reported having daily or weekly angina. During follow-up, myocardial infarction or CHD-related death occurred in 7% of patients without angina or inducible ischemia, in 10% of those with angina alone, in 21% of those with …