Duke Treadmill Score: Difference between revisions
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{{Infobox | {{Infobox medical condition | ||
| name | | name = Duke Treadmill Score | ||
| image | | image = | ||
| caption = | |||
| caption | | field = [[Cardiology]] | ||
| | | symptoms = | ||
| | | complications = | ||
| | | onset = | ||
| | | duration = | ||
| | | types = | ||
| | | causes = | ||
| | | risks = | ||
| | | diagnosis = [[Exercise stress test]] | ||
| | | differential = | ||
| | | prevention = | ||
| | | treatment = | ||
| | | medication = | ||
| | | prognosis = | ||
| | | frequency = | ||
| | | deaths = | ||
| | |||
}} | }} | ||
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== | |||
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== | ||
: | 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== | |||
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=== | |||
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. | |||
==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. | |||
==See Also== | |||
* [[Exercise stress test]] | |||
* [[Coronary artery disease]] | |||
* [[Bruce protocol]] | |||
==References== | |||
* Mark, D. B., Shaw, L., Harrell, F. E., Hlatky, M. A., Lee, K. L., Bengtson, J. R., & Pryor, D. B. (1991). Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. ''New England Journal of Medicine'', 325(12), 849-853. | |||
* Gibbons, R. J., Balady, G. J., Bricker, J. T., Chaitman, B. R., Fletcher, G. F., Froelicher, V. F., ... & Winters, W. L. (2002). ACC/AHA 2002 guideline update for exercise testing: summary article. ''Journal of the American College of Cardiology'', 40(8), 1531-1540. | |||
==External Links== | |||
* [https://www.acc.org/ American College of Cardiology] | |||
* [https://www.heart.org/ American Heart Association] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category: | [[Category:Medical tests]] | ||
[[Category:Prognostic scoring systems]] | |||
Revision as of 02:14, 2 January 2025
| Duke Treadmill Score | |
|---|---|
| Synonyms | N/A |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | |
| Complications | |
| Onset | |
| Duration | |
| Types | |
| Causes | |
| Risks | |
| Diagnosis | Exercise stress test |
| Differential diagnosis | |
| Prevention | |
| Treatment | |
| Medication | |
| Prognosis | |
| Frequency | |
| Deaths | |
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
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
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
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
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.
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.
See Also
References
- Mark, D. B., Shaw, L., Harrell, F. E., Hlatky, M. A., Lee, K. L., Bengtson, J. R., & Pryor, D. B. (1991). Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. New England Journal of Medicine, 325(12), 849-853.
- Gibbons, R. J., Balady, G. J., Bricker, J. T., Chaitman, B. R., Fletcher, G. F., Froelicher, V. F., ... & Winters, W. L. (2002). ACC/AHA 2002 guideline update for exercise testing: summary article. Journal of the American College of Cardiology, 40(8), 1531-1540.
