Evidence on harms was limited , but direct harms seemed minimal ( for resting ECG ) or small ( for exercise ECG ) .
BACKGROUND Coronary heart disease is the leading cause of death in adults .
Screening for abnormalities by using resting or exercise electrocardiography ( ECG ) might help identify persons who would benefit from interventions to reduce cardiovascular risk .
PURPOSE To up date the 2004 U.S. Preventive Services Task Force evidence review on screening for  resting or exercise ECG abnormalities in asymptomatic adults .
Scintigraphic and electrocardiographic evidence of silent coronary artery disease in asymptomatic hypertension: a case-control study.
OBJECTIVES This study was conducted to determine the incidence of physiologically significant coronary artery disease in a group of asymptomatic high risk men with essential hypertension and to assess the validity of noninvasive tests in a subset of these patients undergoing coronary arteriography . METHODS Two hundred twenty-six asymptomatic men ( mean age 61 + /- 8 years ) with essential hypertension and no clinical evidence of coronary artery disease but with at least one additional coronary risk factor were studied prospect ively . Fifty age- and risk factor-matched normotensive subjects were evaluated as a control group . After a minimum of 4 days without medication , subjects underwent stress thallium-201 scintigraphy , exercise and 48-h ambulatory electrocardiography , and echocardiography . Coronary angiography was performed in a subset of 34 ( 40 % ) of 84 patients with one or more positive test results . RESULTS A positive  thallium-201 scintigram  ( 18 % vs. 6 % ; odds ratio 3.4 , confidence interval 0.95 to 10.8 , p = 0.056 ) ,  exercise electrocardiograms ( ECGs ) ( 37 % vs. 13 % ; odds ratio 4.1 , confidence interval 1.5 to 11.2 , p < 0.003 ) and ambulatory ECG  ( 15 % vs. 0 % , p < 0.05 ) were more common in the hypertensive group than in the control group . In the cohort undergoing coronary angiography , thallium-201 scintigraphy was both sensitive and specific for epicardial atherosclerotic coronary disease ( 90 % and 79 % , respectively ) , but positive exercise and ambulatory ECGs occurred frequently in the absence of significant coronary stenoses . In the 39 % of hypertensive patients who had mild to moderate left ventricular hypertrophy , positive exercise and ambulatory ECGs occurred at a higher rate . CONCLUSIONS These findings suggest that physiologically significant coronary artery disease occurs more frequently in asymptomatic hypertensive men than in comparable normotensive control subjects . In the subgroup undergoing coronary arteriography , reversible scintigraphic defects were both sensitive and specific for diagnosing epicardial coronary artery disease , but exercise and ambulatory ECGs appeared to yield frequent false positive results , especially when left ventricular hypertrophy was present . These results indicate that patients with " silent " coronary artery disease can be identified among high risk hypertensive patients , but the appropriate application of such screening in clinical practice remains to be determined
Evidence on harms was limited , but direct harms seemed minimal ( for resting ECG ) or small ( for exercise ECG ) .
BACKGROUND Coronary heart disease is the leading cause of death in adults .
Screening for abnormalities by using resting or exercise electrocardiography ( ECG ) might help identify persons who would benefit from interventions to reduce cardiovascular risk .
PURPOSE To up date the 2004 U.S. Preventive Services Task Force evidence review on screening for  resting or exercise ECG abnormalities in asymptomatic adults .