Clinical Utility of the Exercise ECG in Patients With Diabetes and Chest Pain

Abstract

Objective: The purpose of this study was to determine the characteristics of exercise treadmill testing in diabetic patients presenting with chest pain. Background: The diagnosis of coronary artery disease (CAD) in diabetic patients is confounded by different manifestations of coronary disease than are seen in the general population. Because of the association of diabetes with accelerated CAD, it is critical to assess the diagnostic utility of the standard exercise test in diabetic patients with chest pain. Methods: This study was a retrospective analysis of standard exercise test results in 1,282 male patients without prior myocardial infarction who had undergone coronary angiography and were being evaluated for possible CAD at two Veterans' Administration institutions. Results: In patients with diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 69%; the sensitivity of the exercise test was 47% (95% confidence interval [CI], 41 to 58), and specificity was 81% (95% CI, 68 to 89). In patients without diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 58%; the sensitivity of the exercise test was 52% (95% CI, 48 to 56), and specificity was 80% (95% CI, 76 to 83). The receiver operating characteristic curves were also similar in both diabetic and nondiabetic patients (0.67 and 0.68, respectively).Conclusion: These data demonstrate that the standard exercise test has similar diagnostic characteristics in diabetic as in nondiabetic patients.(CHEST 2001; 119:1576 -1581)

Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus

“…24,25 Elhendy et al 24 evaluated the importance of exercise echocardiography for risk stratification of such patients with known or suspected ischemic heart disease. A total of 563 patients underwent symptom-limited treadmill testing that involved 1 of the 3 following protocols: Bruce, Naughton, or modified Bruce.…”

“…Their data indicated that patients with diabetes mellitus who had an abnormal stress echocardiogram were at greater risk of death or nonfatal myocardial infarction than those with a normal stress echocardiogram. 24 Lee and colleagues 25 sought to determine the characteristics of exercise treadmill testing in patients with diabetes who had angina. They conducted a retrospective analysis of exercise test results in 1282 men who had undergone coronary angioplasty and were without prior myocardial infarction.…”

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

“…[411][412][413][414][415][416] ECG stress testing has an approximate 50% sensitivity and 80% specificity. 401 The positive predictive value for detecting CAD using coronary angiography as the gold standard ranges between 60% and 94% and was higher in men than women.…”

Stress Testing in Patients With Diabetes Mellitus

“…Given the differences in presentation of CAD within the diabetic population and particularly the higher incidence of silent myocardial ischemia, various groups have attempted to evaluate whether the exercise ECG has similar accuracy in a diabetic population. Lee et al 30 (Table 1) retrospectively evaluated 190 diabetic patients among 1282 male veterans presenting with chest pain who underwent an exercise ECG test and coronary angiography within a 4-month period. With standard ECG criteria used to define a positive test, 1 38% of diabetic patients had an abnormal exercise test, whereas 69% had CAD as defined by angiography.…”