Diagnoses and prognoses coronary artery disease based on ECG testing, presence and severity of angina during exercise.

Refer to the text below the score for more information about the variables and the formula involved.

Patients with suspected coronary artery disease may be asked to take a treadmill ECG test which helps diagnose CAD.

The DTS classifies the patient in one of the three risk groups and prognoses 5-year survival, based on duration of exercise, ST-segment deviation (depression or elevation), and the presence and severity of angina.

`DTS = Exercise time in min – (5 x Maximal net ST-segment deviation in mm) – (4 x Angina index)`

 DTS Risk group 5-year survival ≥ +5 Low 99% -10 to +4 Medium 95% < -10 High 79%

Exercise time
Maximal net ST-segment deviation
Angina index
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## Duke Treadmill Score (DTS) Explained

Patients with suspected coronary artery disease may be asked to take a treadmill ECG test which helps diagnose CAD.

Duke Treadmill Score is a weighted index that classifies the patient in one of the three risk groups and prognoses 5-year survival by combining:

• Exercise time using standard Bruce protocol;
• Maximum net ST segment deviation (depression or elevation);
• Exercise-induced angina.

`DTS = Exercise time in min – (5 x Maximal net ST-segment deviation in mm) – (4 x Angina index)`

The typical observed range of DTS is from -25 (highest risk) to +15 (lowest risk), whilst the result interpretation is:

 DTS Risk group 5-year survival ≥ +5 Low 99% -10 to +4 Medium 95% < -10 High 79%

It was also found that in the case of women, a low Duke Treadmill Score is better at excluding ischemic heart disease.

The DTS is usually performed in conjunction with coronary anatomy, left ventricular ejection fraction and other clinical data and CAD risk factors. The 1997 ACC/AHA guidelines for exercise testing advice that patients in the high-risk group are candidates for coronary angiography.

The results may not be conclusive in case there is concomitant significant valvular or congenital heart disease, previous cardiac surgery or if the ECG is uninterpretable due to left bundle branch block.

In the original study by Mark et al. 2,842 consecutive patients with chest pain presentation were analysed. The cohort was divided into two groups, the first was analysed via Cox regression model to create the formula and the second was tested to validate the DTS.

13% of the patients were found to be at high risk; 53%, at moderate risk; and 34% at low risk. The score was found to be clinically useful for stratifying prognosis in patients with suspected coronary artery disease, referred for catheterization.

## References

### Original reference

Mark DB, Hlatky MA, Harrell FE, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987; 106(6):793-800.

### Validation

Mark DB, Shaw L, Harrell FE, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991; 325(12):849-53.

### Other references

Shaw LJ, Hachamovitch R, Redberg RF. Current evidence on diagnostic testing in women with suspected coronary artery disease: choosing the appropriate test. Cardiol Rev 2000; 8(1):65–74.

Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997; 30(1):260-311.

Kwok JM, Miller TD, Christian TF, Hodge DO, Gibbons RJ. Prognostic value of a treadmill exercise score in symptomatic patients with nonspecific ST-T abnormalities on resting ECG. JAMA. 1999; 282(11):1047.

Specialty: Cardiology

System: Cardiovascular

Year Of Study: 1987

Abbreviation: DTS

Article By: Denise Nedea

Published On: July 3, 2020

Last Checked: July 3, 2020

Next Review: July 3, 2025