 
Duke Treadmill Score
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The Duke Treadmill Score (DTS) is a weighted index combining treadmill exercise time using standard Bruce protocol, maximum net ST segment deviation (depression or elevation), and exercise-induced angina. It was developed to provide accurate diagnostic and prognostic information for the evaluation of patients with suspected coronary heart disease. The typical observed range of DTS is from -25 (highest risk) to +15 (lowest risk). A low DTS is actually better at excluding ischemic heart disease in women than men.
| DTS = |
|
Exercise Time - (5 x Max ST) - (4 x Angina Index) |
| Ex Time |
|
Treadmill exercise time |
| Max ST |
|
Maximum net ST deviation (except aVR) |
| Angina Index |
|
Treadmill angina index
|
0. |
No angina during exercise |
|
1. |
Non-limiting angina
|
|
2. |
Exercise limited angina |
|
| DTS |
|
Duke treadmill score |
| Risk |
|
|
>=+5 |
Low risk |
|
+4 to -10
|
Moderate risk
|
|
<= -11 |
High risk |
|
|
|
DTS Risk Category
|
1-Yr Mortality
|
No Stenosis >=75%
|
1 VD >=75%
|
2 VD >=75%
|
3VD >=75% or LM >=75%
|
|
|
Men
|
|
 Low
|
0.9%
|
52.6%
|
22.4%
|
13.6%
|
11.4%
|
|
Mod
|
2.9%
|
17.8%
|
15.6%
|
27.9%
|
38.7%
|
|
High
|
8.3%
|
1.8%
|
9.1%
|
17.5%
|
71.5%
|
|
Women
|
|
Low
|
0.5%
|
80.9%
|
9.4%
|
6.2%
|
3.5%
|
|
Mod
|
1.1%
|
65.1%
|
14.2%
|
8.3%
|
12.4%
|
|
High
|
1.8%
|
10.8%
|
18.9%
|
24.3%
|
46%
|
|
VD = Vessel Disease; LM = Left Main
References
| Mark DB, Hlatky MA, Harrell FE, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Int Med 1987; 106:793-800. | |  |
| | | | | Mark DB, Shaw L, Harrell FE Jr., et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991; 325:849-53. | | |
| | | | | Alexander KP, Shaw L, Delong ER, Mark DB, Peterson ED. Value of exercise treadmill testing in women. J Am Coll Cardiol 1998; 32:1657-64. | | |
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Author: Dr. Chi-Ming Chow  Developer: Edward Brawer Illustrator: Ellen Ho
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