Can exercise tolerance tests reliably diagnose or exclude coronary artery disease?

Exercise tolerance tests, while useful, cannot definitively confirm or exclude coronary artery disease (CAD) on their own. These tests evaluate the response of the cardiovascular system to physical stress, typically aiming to assess functional capacity and identify potential ischemic changes indicated by symptoms or ECG alterations during exercise. However, their limitations stem from factors like false positives and false negatives, variability in individual responses, and the influence of non-cardiac conditions that may affect exercise performance.

In many cases, these tests may be indicative of the presence of CAD, especially when results show significant ST-segment changes or when patients experience angina during the activity. However, the absence of such findings does not entirely rule out the possibility of CAD, particularly in lower-risk individuals or those with atypical presentations. Hence, definitive diagnosis typically requires additional modalities such as coronary angiography, cardiac imaging, or further functional testing.

Using exercise tolerance tests solely as a diagnostic tool can lead to incomplete assessments and potential mismanagement of patients. Thus, while they play a valuable role in the overall evaluation process, it is important to understand their limitations and the need for complementary diagnostic strategies.