Abstract
Patients with diabetes mellitus have a greater risk for coronary artery disease (CAD) than the general population, and CAD is the major cause of morbidity and mortality in this population. Therefore, its early detection is very important to improve the prognosis. Especially, in asymptomatic patients, a proper screening test to detect occult CAD is needed. The Treadmill Test, in this sense, is a useful tool which can be easily performed with low cost for screening for the presence of myocardial ischemia associated with diabetes mellitus.
Figures and Tables
Table 1
MET, metabolic equivalent.
Adapted from Bonow et al. Bonow: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine; 2011[3].
References
1. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, Fonseca V, Gerstein HC, Grundy S, Nesto RW, Pignone MP, Plutzky J, Porte D, Redberg R, Stitzel KF, Stone NJ. American Heart Association. American Diabetes Association. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2007. 115:114–126.
2. Young LH, Wackers FJ, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Heller GV, Iskandrian AE, Wittlin SD, Filipchuk N, Ratner RE, Inzucchi SE. DIAD Investigators. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA. 2009. 301:1547–1555.
3. Bonow RO, Mann DL, Zipes DP, Libby P. Bonow: Braunwald's Heart Disease: A Text book of Cardiovascular Medicine. 2011. 9th ed. Philadelphia: Saunders;168–199. 1392–1409.
4. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O'Reilly MG, Winters WL, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, Smith SC. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee to Update the 1997 Exercise Testing Guidelines. ACC/AHA 2002 guideline update for exercise testing: summary article A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002. 40:1531–1540.
5. Kim MK, Baek KH, Song KH, Kwon HS, Lee JM, Kang MI, Yoon KH, Cha BY, Son HY, Lee KW. Exercise treadmill test in detecting asymptomatic coronary artery disease in type 2 diabetes mellitus. Diabetes Metab J. 2011. 35:34–40.
6. Milan Study on Atherosclerosis and Diabetes (MiSAD) Group. Prevalence of unrecognized silent myocardial ischemia and its association with atherosclerotic risk factors in noninsulin-dependent diabetes mellitus. Am J Cardiol. 1997. 79:134–139.
7. Sacre JW, Jellis CL, Coombes JS, Marwick TH. Diagnostic accuracy of heart-rate recovery after exercise in the assessment of diabetic cardiac autonomic neuropathy. Diabet Med. 2012. 29:e312–e320.
8. Poirier P, Després JP, Bertrand OF. Identifying which patients with diabetes should be tested for the presence of coronary artery disease-the importance of baseline electrocardiogram and exercise testing. Can J Cardiol. 2006. 22:Suppl A. 9A–15A.
9. Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, Dunning A, DeFrance T, Lansky A, Leipsic J, Min JK. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011. 58:1989–1997.