Diabetes & Metabolism Journal

Original Articles

Exercise Treadmill Test in Detecting Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus: Mee Kyoung Kim, Ki Hyun Baek, Ki Ho Song, Hyuk Sang Kwon, Jung Min Lee, Moo Il Kang, Kun Ho Yoon, Bong Yun Cha, Ho Young Son, Kwang Woo Lee; Diabetes Metab J. 2011;35(1):34-40. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.34

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Background

The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD).

Methods

A total of 213 patients with T2DM without typical angina or chest pain were studied between 2002 and 2007. We also evaluated 53 patients with T2DM who had reported chest discomfort using an exercise treadmill test (ETT).

Results

Thirty-one of the 213 asymptomatic patients had positive ETT results. We performed coronary angiography on 23 of the 31 patients with a positive ETT and found that 11 of them had significant coronary stenosis. The main differences between the patients with significant stenosis and those with a negative ETT were age (63.1±9.4 vs. 53.7±10.1 years, P=0.008) and duration of diabetes (16.0±7.5 vs. 5.5±5.7 years, P<0.001). The positive predictive value (PPV) of the ETT was calculated to be 47.8%. The PPV of the ETT increased to 87.5% in elderly patients (≥60 years) with a long duration of diabetes (≥10 years). The latter value is similar to that of patients with T2DM who presented with chest discomfort or exertional dyspnea. The PPV of the ETT in symptomatic patients was 76.9%.

Conclusion

In the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes ≥10 years.

Citations

Citations to this article as recorded by

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Pakistan Journal of Health Sciences.2023; : 126. CrossRef
Prevalence of Coronary Artery Disease in Asymptomatic type 2 Diabetes Mellitus Patients with Invasive Correlation in North India
V Kumar, B Yadav, A Nachankar
Indian Journal of Endocrinology and Metabolism.2023; 27(2): 133. CrossRef
Anatomical and Neuromuscular Factors Associated to Non-Contact Anterior Cruciate Ligament Injury
Marc Dauty, Vincent Crenn, Bastien Louguet, Jérôme Grondin, Pierre Menu, Alban Fouasson-Chailloux
Journal of Clinical Medicine.2022; 11(5): 1402. CrossRef
Prevalence of Asymptomatic Silent Myocardial Ischemia among Type 2 Diabetes Mellitus Patients in Bangalore - A Hospital-Based Cross-Sectional Study
Nagappa H Handargal, Shristi J Shetty
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Cureus.2020;[Epub] CrossRef
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Malepati Sai Sarath Reddy, Uma Mylandlahalli Anandkumar, Srinivasa Rao
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Frequency of Silent Myocardial Ischemia Detected by Thallium-201 SPECT in Patients with Type 2 Diabetes.: Dong Woo Kim, Eun Hee Jung, Eun Hee Koh, Min Seon Kim, Joong Yeol Park, Seung Whan Lee, Seong Wook Park, Jin Sook Ryu, Ki Up Lee; Korean Diabetes J. 2009;33(3):225-231. Published online June 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.3.225

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Abstract PDF: BACKGROUND
Silent myocardial ischemia (SMI) is more common in diabetic patients than among the general population. It is not yet established whether a routine screening test for SMI is necessary, and which screening test would be most useful. The purpose of this study was to estimate the prevalence of SMI detected by Thallium-201 perfusion single photon emission computed tomography (SPECT) in type 2 diabetic patients. METHODS: A total of 173 asymptomatic type 2 diabetic patients were included in the study. Thallium-201 perfusion SPECT was performed to screen for SMI. RESULTS: Among the 173 patients, abnormal perfusion patterns were found in 11 patients. Coronary angiography was carried out for these patients, and significant coronary artery stenosis was found in ten of them (positive predictive value; 90.9%). There was a significant association between SMI and overt albuminuria (OR = 7.33, 95% CI, 1.825-29.437). CONCLUSION: Thallium-201 perfusion SPECT is not sensitive enough to identify SMI, but is accurate in detecting decreased myocardial perfusion. This may be a useful screening tool for detecting SMI in type 2 diabetic patients with impaired renal function.

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