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| {{Infobox diagnostic
| | The '''Duke Treadmill Score''' (DTS) is a clinical tool used to predict the risk of [[coronary artery disease]] (CAD) and to assess the prognosis of patients undergoing an [[exercise stress test]]. It is particularly useful in evaluating patients with suspected ischemic heart disease. |
| | name = Duke Treadmill Score
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| | purpose = predicting the risk of ischemia or infarction
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| | DiseasesDB = <!--{{DiseasesDB2|numeric_id}}-->
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| '''Duke Treadmill Score''' is one of the tools for predicting the risk of [[ischemia]] or [[infarction]] in the [[heart muscle]].<ref name=Alessi2010C12>{{cite book |first1=Ann Marie |last1=Alessi |chapter=Exercise Stress Testing |pages=109–18 |chapterurl={{Google books|F4lJGt0jr8MC|page=109|plainurl=yes}} |year=2010 |title=Nuclear Cardiology Technology Study Guide (Voice)| isbn=9780932004833 }}</ref> The calculation is done based on the information obtained from an [[exercise test]] by this formula: | |
| :[exercise duration by [[Bruce protocol]]] - [ 5 × (maximal [[ST elevation]] or [[ST depression|depression]])] - [4 × (treadmill angina index)]
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| In which, the exercise duration is written in "minutes" and the ST changes in "millimetres".<ref name=Alessi2010C12/> Angina index will be zero if no pain appears during the exercise, one if the pain is limited to the exercise period ([[Angina#Stable angina|typical angina]]), and two if non-limiting pain occurs which will be a reason to stop exercise test.<ref>{{cite web |title=Duke Treadmill Score |url={{Google books|jyy7rceM4awC|page=172|plainurl=yes}} |page=172 }} in {{Cite book |doi=10.1007/978-0-387-76597-6_9 |chapter=Stratifying Symptomatic Patients Using the Exercise Test and Other Tools |title=Exercise Stress Testing for Primary Care and Sports Medicine |pages=167–192 |year=2009 |last1=White |first1=Russell D |last2=Goldschlager |first2=Nora |isbn=978-0-387-76596-9 }}</ref><ref>{{cite journal |doi=10.1016/j.amjcard.2008.07.020 |pmid=18993164 |title=Age and Double Product (Systolic Blood Pressure × Heart Rate) Reserve-Adjusted Modification of the Duke Treadmill Score Nomogram in Men |journal=The American Journal of Cardiology |volume=102 |issue=10 |pages=1407–1412 |year=2008 |last1=Sadrzadeh Rafie |first1=Amir H |last2=Dewey |first2=Frederick E |last3=Sungar |first3=Gannon W |last4=Ashley |first4=Euan A |last5=Hadley |first5=David |last6=Myers |first6=Jonathan |last7=Froelicher |first7=Victor F }}</ref>
| | ==History== |
| | The Duke Treadmill Score was developed at [[Duke University]] in the 1980s as a means to improve the diagnostic and prognostic value of the exercise stress test. It was designed to provide a more quantitative assessment of the risk of coronary artery disease and to guide clinical decision-making. |
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| One year [[Mortality rate|mortality]] for the results of the Duke treadmill score in one study has been reported as:<ref>{{cite book|url=https://www.stjoesannarbor.org/documents/mhvi/clinicalreferences/stable_pocket.pdf|title=Management of Patients With Chronic Stable Angina|last=|first=|date=March 2003|isbn=|series=ACC/AHA Pocket Guideline|location=|pages=49}}</ref>
| | ==Calculation== |
| | The Duke Treadmill Score is calculated using the following formula: |
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| :less or equal to -11: 5.25% | | : '''DTS = Exercise time (minutes) - (5 × ST deviation in mm) - (4 × Angina index)''' |
| :4 to -10: 1.25%
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| :more or equal to 5: 0.25%
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| ==Further reading==
| | * '''Exercise time''' is measured in minutes on a standard [[Bruce protocol]] treadmill test. |
| *{{cite journal |doi=10.1016/S0735-1097(02)01769-2 |title=Prognostic value of the Duke treadmill score in the elderly |journal=Journal of the American College of Cardiology |volume=39 |issue=9 |pages=1475–1481 |year=2002 |last1=Kwok |first1=Jennifer M.F |last2=Miller |first2=Todd D |last3=Hodge |first3=David O |last4=Gibbons |first4=Raymond J }} | | * '''ST deviation''' refers to the maximum ST-segment deviation (either depression or elevation) in millimeters observed during the test. |
| *{{cite journal |doi=10.1016/j.amjcard.2005.03.078 |pmid=16054460 |title=Prognostic Value of the Duke Treadmill Score in Asymptomatic Women |journal=The American Journal of Cardiology |volume=96 |issue=3 |pages=369–375 |year=2005 |last1=Gulati |first1=Martha |last2=Arnsdorf |first2=Morton F |last3=Shaw |first3=Leslee J |last4=Pandey |first4=Dilip K |last5=Thisted |first5=Ronald A |last6=Lauderdale |first6=Diane S |last7=Wicklund |first7=Roxanne H |last8=Al-Hani |first8=Arfan J |last9=Black |first9=Henry R }}
| | * '''Angina index''' is scored as follows: |
| *{{cite journal |doi=10.1016/S0002-9149(99)00565-2 |title=Long-term prognostic value of duke treadmill score and exercise thallium-201 imaging performed one to three years after percutaneous transluminal coronary angioplasty |journal=The American Journal of Cardiology |volume=84 |issue=11 |pages=1323–1327 |year=1999 |last1=Ho |first1=Kheng-Thye |last2=Miller |first2=Todd D |last3=Holmes |first3=David R |last4=Hodge |first4=David O |last5=Gibbons |first5=Raymond J }} | | ** 0 = No angina |
| *{{cite journal |pmid=15632026 |url=http://jnm.snmjournals.org/cgi/pmidlookup?view=long&pmid=15632026 |year=2005 |last1=Liao |first1=L |title=Prediction of death and nonfatal myocardial infarction in high-risk patients: A comparison between the Duke treadmill score, peak exercise radionuclide angiography, and SPECT perfusion imaging |journal=Journal of Nuclear Medicine|volume=46 |issue=1 |pages=5–11 |last2=Smith Wt |first2=4th |last3=Tuttle |first3=R. H |last4=Shaw |first4=L. K |last5=Coleman |first5=R. E |last6=Borges-Neto |first6=S }}
| | ** 1 = Non-limiting angina |
| *{{cite journal |doi=10.1016/j.ahj.2004.09.058 |pmid=16169334 |title=Prognostic value of the Duke Treadmill Score in diabetic patients |journal=American Heart Journal |volume=150 |issue=3 |pages=516–521 |year=2005 |last1=Lakkireddy |first1=Dhanunjaya R |last2=Bhakkad |first2=Jyothi |last3=Korlakunta |first3=Hema L |last4=Ryschon |first4=Kay |last5=Shen |first5=Xuedong |last6=Mooss |first6=Aryan N |last7=Mohiuddin |first7=Syed M }}
| | ** 2 = Exercise-limiting angina |
| *{{cite journal |doi=10.1016/j.ahj.2006.03.015 |pmid=16781248 |title=Comparison of exercise echocardiography and the Duke treadmill score for risk stratification in patients with known or suspected coronary artery disease and normal resting electrocardiogram |journal=American Heart Journal |volume=151 |issue=6 |pages=1324.e1–1324.e10 |year=2006 |last1=Peteiro |first1=Jesús |last2=Monserrrat |first2=Lorenzo |last3=Piñeiro |first3=Miriam |last4=Calviño |first4=Ramon |last5=Vazquez |first5=Jose Manuel |last6=Mariñas |first6=Javier |last7=Castro-Beiras |first7=Alfonso }}
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| *{{cite journal |doi=10.1016/j.ijcard.2003.11.045 |pmid=15708171 |title=Relation between Duke treadmill score and coronary flow reserve using transesophageal Doppler echocardiography in patients with microvascular angina |journal=International Journal of Cardiology |volume=98 |issue=3 |pages=403–408 |year=2005 |last1=Youn |first1=Ho-Joong |last2=Park |first2=Chul-Soo |last3=Moon |first3=Keon-Woong |last4=Oh |first4=Yong-Seok |last5=Chung |first5=Wook-Sung |last6=Kim |first6=Jae-Hyung |last7=Choi |first7=Kyu-Bo |last8=Hong |first8=Soon-Jo }}
| | ==Interpretation== |
| *{{cite journal |doi=10.1016/j.amjcard.2008.07.020 |pmid=18993164 |title=Age and Double Product (Systolic Blood Pressure × Heart Rate) Reserve-Adjusted Modification of the Duke Treadmill Score Nomogram in Men |journal=The American Journal of Cardiology |volume=102 |issue=10 |pages=1407–1412 |year=2008 |last1=Sadrzadeh Rafie |first1=Amir H |last2=Dewey |first2=Frederick E |last3=Sungar |first3=Gannon W |last4=Ashley |first4=Euan A |last5=Hadley |first5=David |last6=Myers |first6=Jonathan |last7=Froelicher |first7=Victor F }} | | The Duke Treadmill Score stratifies patients into three risk categories: |
| *{{cite journal |doi=10.1056/NEJM199109193251204 |pmid=1875969 |title=Prognostic Value of a Treadmill Exercise Score in Outpatients with Suspected Coronary Artery Disease |journal=New England Journal of Medicine |volume=325 |issue=12 |pages=849–853 |year=1991 |last1=Mark |first1=Daniel B |last2=Shaw |first2=Linda |last3=Harrell |first3=Frank E |last4=Hlatky |first4=Mark A |last5=Lee |first5=Kerry L |last6=Bengtson |first6=James R |last7=McCants |first7=Charles B |last8=Califf |first8=Robert M |last9=Pryor |first9=David B }} | | |
| <references />
| | * '''Low risk''': DTS ≥ +5 |
| {{adapted}} | | * '''Intermediate risk''': DTS between -10 and +4 |
| [[Category:Cardiac anatomy]]
| | * '''High risk''': DTS ≤ -11 |
| | |
| | ===Low Risk=== |
| | Patients with a low-risk Duke Treadmill Score have an excellent prognosis, with an annual mortality rate of less than 1%. These patients may not require further invasive testing and can often be managed with lifestyle modifications and medical therapy. |
| | |
| | ===Intermediate Risk=== |
| | Patients with an intermediate-risk score have a moderate risk of coronary events. Further evaluation with imaging studies such as [[myocardial perfusion imaging]] or [[coronary angiography]] may be warranted to better assess the extent of coronary artery disease. |
| | |
| | ===High Risk=== |
| | High-risk patients have a significantly increased risk of cardiac events, with an annual mortality rate exceeding 3%. These patients often require more aggressive investigation and management, including consideration for [[coronary revascularization]] procedures. |
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| | ==Clinical Use== |
| | The Duke Treadmill Score is widely used in clinical practice to guide the management of patients with suspected coronary artery disease. It helps in decision-making regarding the need for further diagnostic testing and the intensity of therapeutic interventions. |
| | |
| | ==Limitations== |
| | While the Duke Treadmill Score is a valuable tool, it has limitations. It may not be applicable to patients unable to perform an adequate exercise test or those with baseline [[electrocardiogram]] abnormalities that preclude accurate ST-segment analysis. Additionally, it does not account for other clinical factors such as [[age]], [[gender]], or [[comorbidities]] that may influence the risk of coronary artery disease. |
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| | ==See Also== |
| | * [[Exercise stress test]] |
| | * [[Coronary artery disease]] |
| | * [[Bruce protocol]] |
| | |
| | ==External Links== |
| | * [https://www.acc.org/ American College of Cardiology] |
| | * [https://www.heart.org/ American Heart Association] |
| | {{nt}} |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Heart diseases]] | | [[Category:Medical tests]] |
| | [[Category:Prognostic scoring systems]] |
The Duke Treadmill Score (DTS) is a clinical tool used to predict the risk of coronary artery disease (CAD) and to assess the prognosis of patients undergoing an exercise stress test. It is particularly useful in evaluating patients with suspected ischemic heart disease.
History[edit]
The Duke Treadmill Score was developed at Duke University in the 1980s as a means to improve the diagnostic and prognostic value of the exercise stress test. It was designed to provide a more quantitative assessment of the risk of coronary artery disease and to guide clinical decision-making.
Calculation[edit]
The Duke Treadmill Score is calculated using the following formula:
- DTS = Exercise time (minutes) - (5 × ST deviation in mm) - (4 × Angina index)
- Exercise time is measured in minutes on a standard Bruce protocol treadmill test.
- ST deviation refers to the maximum ST-segment deviation (either depression or elevation) in millimeters observed during the test.
- Angina index is scored as follows:
- 0 = No angina
- 1 = Non-limiting angina
- 2 = Exercise-limiting angina
Interpretation[edit]
The Duke Treadmill Score stratifies patients into three risk categories:
- Low risk: DTS ≥ +5
- Intermediate risk: DTS between -10 and +4
- High risk: DTS ≤ -11
Low Risk[edit]
Patients with a low-risk Duke Treadmill Score have an excellent prognosis, with an annual mortality rate of less than 1%. These patients may not require further invasive testing and can often be managed with lifestyle modifications and medical therapy.
Intermediate Risk[edit]
Patients with an intermediate-risk score have a moderate risk of coronary events. Further evaluation with imaging studies such as myocardial perfusion imaging or coronary angiography may be warranted to better assess the extent of coronary artery disease.
High Risk[edit]
High-risk patients have a significantly increased risk of cardiac events, with an annual mortality rate exceeding 3%. These patients often require more aggressive investigation and management, including consideration for coronary revascularization procedures.
Clinical Use[edit]
The Duke Treadmill Score is widely used in clinical practice to guide the management of patients with suspected coronary artery disease. It helps in decision-making regarding the need for further diagnostic testing and the intensity of therapeutic interventions.
Limitations[edit]
While the Duke Treadmill Score is a valuable tool, it has limitations. It may not be applicable to patients unable to perform an adequate exercise test or those with baseline electrocardiogram abnormalities that preclude accurate ST-segment analysis. Additionally, it does not account for other clinical factors such as age, gender, or comorbidities that may influence the risk of coronary artery disease.
See Also[edit]
External Links[edit]
