Cardiology Question 33 Instructor

What is the Duke Treadmill Score (DTS) and how it is used in exercise stress testing (EST) to help risk stratify patients who presented with acute coronary syndrome (ACS)?

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 * Max ST) – (4 * Angina Index)

Ex Time Treadmill exercise time [min]
MaxST Maximum netST deviation (except aVR) [min]
Angina Index Treadmill Angina Index [no unit]

  1. No angina during exercise
  2. Non-limiting angina
  3. Exercise limited angina
DTS Duke Treadmill Score [no unit]
Risk >=+5 (Low risk)
+4 to -10 (Moderate risk)
<=-11 (High risk)

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.

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