Computer applications in the interpretation of the exercise electrocardiogram

The exercise electrocardiogram remains the noninvasive diagnostic test of f irst choice in patients with coronary artery disease. While new technology offers novel diagnostic possibilities and the ability to assess patients un suitable for exercise testing, no other investigation has to this point fur nished the quality of functional information and value-for-predictive accur acy of exercise electrocardiography. In this article, we describe how this central position in the work up of th e cardiac patient has been secured through the evolution of the microproces sor. Particularly important has been its ability to harness and present lar ge volumes of raw data, to derive and manipulate multivariate equations for diagnostic prediction, and to run 'expert' systems which can pool demograp hic and exercise test data, calculate risk scores, and prompt the nonexpert with advice on current management. These key features explain the pivotal role of the exercise test in the diagnostic, and increasingly prognostic, a rmoury of the cardiovascular clinician.