Exercise ECG To assess the risk of cardiovascular events in patients who are able to exercise to an adequate workload and have an interpretable resting ECG, exercise is the preferred stressor because it provides an objective assessment of functional capacity and correlative information with activities of daily living. The occurrence of ST-segment depression at a reduced workload or persisting into recovery coupled with exertional symptoms is associated with a high risk of cardiovascular mortality.302 Other risk markers for mortality include low exercise capacity (generally defined as less than stage II of the Bruce protocol or #20% age- and sex-predicted val- ues),118 failure to increase systolic BP to .120 mm Hg or a sustained .10 mm Hg decrease from resting values during exercise, complex ventricular ectopy or arrhythmias during stress or recovery, and delayed heart rate recovery (eg, ,10- or 12-beats-per-minute reduction in the first minute).303 The Duke treadmill score and the Lauer nomogram score are validated predictive instruments that incorporate parameters from an exercise ECG test. The Duke treadmill score includes duration of exercise, severity of ST-depression or elevation, and angina (limiting and nonlimiting); has been demonstrated to be highly predictive across an array of patient populations, including women and men with suspected and known SIHD; and has been shown to provide independent risk information beyond clinical data, coronary anatomy, and LVEF.126,177 It stratifies patients into risk groups that could prove useful for patient management, as follows: no further testing for low- risk patients, consideration for invasive testing for high-risk patients, and stress imaging for the intermediate-risk patients. By comparison, the Lauer score incorporates clinical vari- ables, which results in more effective classification of low- risk (,1% annual mortality rate) patients.248 3.2.2.5. 