Lead specificity of the maximum ST/heart rate slope response.

Sir, Once more correspondence columns have borne witness to the confusion caused by the Leeds exercise test. Yet again Professor Linden and his colleagues have been able to claim that their protocol has not been adhered to-and of course on this occasion they are correct in that respect.'2 They have, however, chosen to ignore other studies that have followed their protocol meticulously and that have, nevertheless, failed to reproduce their results.34 This has surely now reached a point for real concern to be expressed. A considerable amount of time and money, much of the latter from charitable sources, has been spent trying to confirm the perfect accuracy of this test and this has proved a wild goose chase. This might be a cause for some amusement were the competition for scarce research funds not so intense. Nevertheless, the alleged usefulness of this test has been widely and uncritically accepted in many countries. There is reason to believe that the management ofmany patients may have been largely determined by the result of a Leeds exercise test, and of course this could well result in quite inappropriate decisions with regard to further investigation and treatment in individual cases. The fact is that the test works only in Leeds. Nobody else, using the unmodified Leeds protocol, has been able to reproduce the results, and surely therefore the test must now either be abandoned or else all patients undergoing it must be sent to Professor Linden's unit since that would appear to be the only place where it can be properly performed and interpreted. It is of interest that the recent letter from Professor Linden and Dr Mary seems to indicate that the test, even in Leeds, is no longer perfect so perhaps the time has come for it to be abandoned.