[The diagnostic exercise test in XXXX . Proposal for a more rigorous and efficacious interpretation].

@entity662 @entity1 @entity308 @entity301 @entity1188 @entity158 @entity453
Although exercise stress testing does not allow certain diagnosis of @entity453 , its interpretation should not necessarily be vague. By using the Bayes theorem and the many studies available we can now quantify the probability of a correct result for each individual case. Three parameters need to be known to undertake this calculation; the prevalence of the disease and the sensitivity and specificity of the investigation. The prevalence of the disease is beginning to be recognised taking into account the character of the @entity158 . Four groups of increasing prevalence can thereby be defined: absence of @entity662 , @entity158 , @entity158 . Within each of these groups the prevalence of @entity301 is higher in @entity1 and increases with age. Information about the prevalence of multivessel disease after @entity1188 is more limited. Only two groups can be distinguished which do not take symptoms, age or sex into consideration. The prevalence is 57% after anterior and 65% after inferior @entity1188 . The sensitivity and specificity of stress testing can be determined by comparison with coronary angiography or, when this is available, by following up the @entity1 . These parameters depend mainly on the methodology which should be strictly defined. When only significant ST @entity308 is considered, the overall sensitivity and specificity of exercise stress testing is 70% and 80% respectively. These results vary according to the particular context; in @entity1 , the sensitivity and specificity are 72% and 75% respectively; in asymptomatic subjects the sensitivity and specificity are 50% and 85% respectively. With regards to the detection of multivessel disease after anterior @entity1188 , the sensitivity and specificity are 58 and 85% respectively and after inferior @entity1188 , 85 and 84% respectively. The use of diagnostic probability based on these parameters should lead to unambiguous practical management of @entity1 related to the degrees of probability obtained. The underlying principles of this diagnostic approach cannot be questioned as they are based on a well established mathematical formula. However, much work remains to be done, on the one hand to determine the exact prevalence of @entity301 , and on the other hand to improve the sensitivity of exercise stress testing.
