Diagnostic Value of Duke Treadmill Score in Predicting Coronary Lesions Severity in Patients with Suspected Stable Coronary Artery Diseases


Background: Duke Treadmill Score (DTS) is a well known score to stratify prognosis with good diagnostic value in predicting number of diseased coronary arteries in ischemic heart disease patient. DTS has also been shown to have a strong correlation with the severity of coronary lesion based on the Syntax score. However, the diagnostic value of DTS in predicting the coronary lesions severity based on Syntax score has not been well established.

Methods: Cross-sectional study was performed in Dr. Sardjito General Hospital based on data from 1st January 2012. Patients with positive exercise test results and already had coronary angiography were included in the study. DTS was calculated based on the assessment of the exercise test result and Syntax score I was measured from the coronary angiography result.

Results: There were 76 patients with average age of 56.64±7.41 year old consisting of 53 male subjects (70%) and 23 female subjects (30%). Hypertension was found to be the most common risk factors in 57 subjects (75%), dyslipidaemia in 33 subjects (43.3%), Diabetes Mellitus in 27 subjects (35.5%), smoking in 24 subjects (31.6%) and family history in 1 subject (1.3%). Subjects with high Syntax score and the low Syntax score were found in 30 subjects (39.5%) and 46 subjects (60.5%) respectively. In this study, the DTS diagnostic value in predicting high Syntax score was determined by the value of area under the curve based on the the Receiver Operating Characteristic (ROC) curve analysis was 92% (95% CI: 86%-97%, p<0.0001). Moreover, DTS with value -8.5had 83% sensitivity, 82% specificity, 75% positive predictive value, 88% negative predictive value, and 83% accuracy to predict high Syntax score.

Conclusion: DTS has a good diagnostic value in predicting coronary lesions severity, particularly in patients with suspected stable coronary artery diseases. DTS value of -8.5 has shown to have the best cut point in this study.


Download data is not yet available.


1. Lilly SL. Pathophysiology of Heart Diseases 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2011.

2. Tardif CJ. 2010. Coronary Artery Diseases in 2010. European Heart Journal 12 (supplement C), C2-C10 doi:10.1093/eurheartj/suq014.

3. WHO. 2004. The global burden of disease: 2004 update. www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html.

4. Delima, Mihardja L and Siswoyo H. Prevalensi dan Faktor Determinan Penyakit Jantung di Indonesia. Buletin Penelitian Kesehatan. 2009;37:142-159.

5. Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Cali RM and Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Annals of Internal Medicine. 1987;106:793-800.

6. Mark DB, Shaw L., Harrell FE and Hlatky MA. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. New England Journal of Medicine. 1991;325:849-53.

7. Shaw L, Peterson E, Shaw L, Kesler K, DeLong ER, Harrell FE, Muhlbaier LH and Mark DB. Use of Prognostic Treadmill Score in Identifying Diagnostic Coronary Diseases Subgroups. Circulation. 1998;98:1622-1630.

8. Acar Z, Korkmaz L, Agac M, Erkan H, Dursun I, Kalaycioglu E, Kiris G and Celik S. Relationship Between Duke Treadmill Score and Coronary Artery Lesion Complexity. Clinical and Investigative Medicine. 2012;35:6.

9. Dahlan S. Penelitian Diagnostik. Jakarta: Salemba Medika; 2009.

10. Fearon WF., Gauri AJ.,Myers J, Raxwal VK, Atmood JE., Froelicher VF. A comparison treadmill score to diagnose coronary artery diseases. Clinical Cardiology. 2002;25;117-122.

11. Gibbons RJ, Balady GJ, Bricker TJ, Chaitman RB, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O’Reilly MG and Winters WL. ACC/AHA 2002 Guideline Update for Exercise Testing. American College of Cardiology Foundation and American Heart Association; 2002.

12. Tamargo JA, Ambrosio SM, Tarin ER, Salinas VA, Fernandez MM, Aguado GM, Alvarez VB, Tassa CM. Angiographic evaluation of high rish treadmill score in patient with stable angina according to sex, age or use of drugs with negative chronotropic effect. Revista Espanola de Cardiologia. 2005;59(5);448-57.

13. Chaitman BR, Bourassa MG, Davis K, Rogers WJ, Tyras DH, Kennedy JW, Fisher L, Judkins MP, Mock MB and Killip T. Angiographic prevalence of high risk coronary artery diseases in patient subset (CASS). Circulation. 1981;64:360-367.

14. Gauri AJ, Raxwal VK, Roux L, Fearon WF,Froelicher VF. Effects of chronotropic incompetence and beta blocker use on the exercise treadmill test in men. American Heart Journal. 2001;142(1):136-41.

15. Srivastava SC, Katval VK, Jagdish, Gupta S, Mohan R. Interpretation of treadmill stress test in patient with coronary artery disease receiving beta blocker therapy. Journal Association Physicians India.1991;39(2):186-90.

16. Diercks DB, Kirk JD, Turnipseed SD, Amsterdam EA. Utility of immediate exercise treadmill testing in patients taking beta blockers or calcium channel blockers. American Journal of Cardiology. 2002;90(8):882-5.

17. Fletcher FG, Ades PA, Kligfield P, Arena R, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pena IL, Rodney R, Simos DA, Williams MA and Bazzare T. Exercise standards for testing and training: A scientific statement from the American Heart Association. Circulation.2013;128:873-934.

18. Radi B, Sarvasti D, Andiarso I, Tadjoeddin Y. Buku pedoman pemeriksaan interpretasi dan pelaporan uji latih jantung: Interpreting the exercise test. Jakarta: Pokja PERKI; 2013.

19. Handler CE, Sowton E. A comparison of the Naughton and modified Bruce treadmill protocol exercise protocols in their ability to detect ischemic abnormalities six weeks after myocardial infarction.European Society of Cardiology. 1984;5(9):752-755.

20. Pignone M, Brown FA, Pletcher M and Tice AJ. Screening for asymptomatic coronary artery diseases: A systematic review for the US preventive service task force. Agency for Healthcare Research and Quality US Department of Health and Human Services; 2003. http://www.ahrq.gov.

21. Mohr F, Claude M, Kappetein P, Feldman T, Stahle E, Colombo A, Mack MJ, Holmes DR, Morel MA, Dyck NV, Houle VM, Dawkins KD and Serruys PW. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary diseases: 5-year follow up of the randomised, clinical SYNTAX trial. Lancet. 2013;381:629-38.
Abstract views: 82   
PDF downloads: 0   
How to Cite
Diagnostic Value of Duke Treadmill Score in Predicting Coronary Lesions Severity in Patients with Suspected Stable Coronary Artery Diseases. (2017). Indonesian Journal of Cardiology, 37(2), 65-74. https://doi.org/10.30701/ijc.v37i2.565
Clinical Research