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 .
Sensitivity of exercise electrocardiography for acute cardiac events during moderate and strenuous physical activity. The Lipid Research Clinics Coronary Primary Prevention Trial.
We determined whether the exercise electrocardiogram predicted acute cardiac events during moderate or strenuous physical activity among 3617 asymptomatic , hypercholesterolemic men ( age range , 35 to 59 years ) who were followed up in the Coronary Primary Prevention Trial .  Submaximal exercise test results were obtained at entry and at annual follow-up visits in years 2 through 7 . ST-segment depression or elevation ( greater than or equal to 1 mm or 10 microV-sec ) was considered to be a positive test result . The circumstances that surrounded each nonfatal myocardial infa rct ion and coronary heart disease death were determined through a record review . The cumulative incidence of activity-related acute cardiac events was 2 % during a mean follow-up period of 7.4 years . The risk was increased 2.6-fold in the presence of clinical ly silent , exercise-induced , ST-segment changes at entry ( 95 % confidence interval [ Cl ] , 1.3 to 5.2 ) after adjustment for 11 other potential risk factors . Of 62 men who experienced an activity-related event , 11 had a positive test result at entry ( sensitivity , 18 % ; 95 % Cl , 8 to 27 ) . The specificity of the entry exercise test was 92 % ( 95 % Cl , 91 to 93 ) . The sensitivity and specificity were similar when the length of follow-up was restricted to 1 year after testing . For a newly positive test result on a follow-up visit , the sensitivity was 24 % ( 95 % Cl , 12 to 36 ) , and the specificity was 85 % ( 95 % Cl , 84 to 86 ) ; for any positive test result during the study ( mean number of tests per subject , 6.2 ) , the sensitivity was 37 % ( 95 % Cl , 25 to 49 ) , and the specificity was 79 % ( 95 % Cl , 77 to 80 ) . Our findings suggested that the presence of clinical ly silent , exercise-induced , ischemic ST-segment changes on a submaximal test was associated with an increased risk of activity-related acute cardiac events . However , this test was not sensitive when used to predict the occurrence of activity-related events among asymptomatic , hypercholesterolemic men . For this reason , the utility of the submaximal exercise test to assess the safety of physical activity among asymptomatic men at risk of coronary heart disease is likely to be limited
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 .