A five-year follow-up of 888 asymptomatic men and women without known coronary heart disease (CHD) who had a maximal treadmill stress test (MTST) revealed a CHD incidence of 1.1% per year. In women, exercise duration of 3 minutes or less by the Ellestad protocol correlated with subsequent development of CHD (p less than 0.001), although abnormal ST-segment and R-wave responses did not. In men 40 years of age or younger, the MTST did not correlate with subsequent CHD. In men older than 40 years, ischemic ST response (p less than 0.01), an increase or no change in R wave (p less than 0.01), and an exercise duration of 5 minutes of less (p less than 0.001) all correlated with subsequent development of CHD. Five of five men (100%) who had all three criteria developed CHD within 5 years. When men older than 40 years who had all three criteria either present or absent were considered, specificity was 100%. The sensitivity, specificity, predictive value of an abnormal test, and risk ratio for developing CHD within 5 years for the various MTST criteria alone and in combination are tabulated.

The double Master's test, the maximal treadmill stress test, the resting apexcardiogram, and the postexercise apexcardiogram significantly correlated with the development of subsequent coronary heart disease within five years in 100 asymptomatic persons. The maximal treadmill stress test correlated better than the double Master's test in predicting subsequent coronary heart disease. The presence of both an abnormal maximal treadmill stress and an abnormal a-wave ratio in the postexercise apexcardiogram had the best value in predicting subsequent coronary heart disease.

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One hundred asymptomatic women, mean age 51, had simultaneous phonocardiograms and electrocardiograms at rest and after a double Master’s test. A fourth heart sound was present at rest in 13 % and after exercise in 32% of them. A third heart sound was present at rest in 2% and after exercise in 17% of these asymptomatic women. All women who had a third heart sound at rest also had a fourth heart sound at rest; all women who had a third heart sound after exercise had a fourth heart sound after exercise. Two of the 100 women (2 %) had ≧ 1.0 mm ischemic ST-segment depression, and 6 % had ≧ 0.5 mm ischemic ST-segment depression. After exercise, 34 % of the women had either a fourth heart sound or ≧ 0.5 mm ischemic ST-segment depression, and 20 % had either a third heart sound or ≧ 0.5 mm ischemic ST-segment depression. Postmenopausal women had a higher incidence of post-exercise third and fourth heart sounds and ischemic ST-segment depression than did premenopausal women.