Cardiovascular Diagnostic Modalities In Diabetes Patients

Table 2-3. Summary of Studies Using Stress Testing in the Diagnosis of Suspected Coronary Artery Disease in Diabetic Patients

Type of Test Study* N Reference Standard Sensitivity (%) Specificity (%) PPV (%) NPV (%)

ECG Lee et al 190 Angiography 47 81 85 41

DSE Hennessy et al 52 Angiography 82 54 84 50

Nuclear Kang et al 138 Angiography 86 56 NA NA

*Full references for studies can be found in the source article.

ECG, exercise electrocardiographic stress test; DSE, dobutamine stress echocardiography; NA, not available; NPV, negative predictive value; PPV, positive predictive value.

From Albers AR, Krichavsky MZ, Balady GJ: Stress testing in patients with diabetes mellitus: Diagnostic and prognostic value. Circulation 2006;113:583-592.

Table 2-4. Summary of Studies Using Stress Testing in the Diagnosis of Coronary Artery Disease in Asymptomatic Diabetic Patients

Type of Test

Study*

N

Reference Standard

ECG

Blandine et al

98

Ang

ography

ECG

Koistinen et al

136

Ang

ography

ECG

Bacci et al

206

Ang

ography

ECG

Penfornis et al

56

Ang

ography

DSE

Penfornis et al

56

Ang

ography

Nuclear

Blandine et al

1 03

Ang

ography

Nuclear

Wackers et al

1123

None

Nuclear

Rajagopalan et al

1427

Angiography

Nuclear

Penfornis et al

56

Angiography

Sensitivity (%)

Specificity (%)

PPV (%)

NPV (%)

NA

NA

90

NA

NA

NA

94

NA

NA

NA

79

NA

NA

NA

60

NA

NA

NA

69

NA

NA

NA

63

NA

NA

NA

NA

NA

92

68

89

60

NA

NA

75

NA

*Full references for studies can be found in the source article.

DSE, dobutamine stress echocardiography; ECG, exercise electrocardiographic stress test; NA, not available; NPV, negative predictive value; PPV, positive predictive value.

From Albers AR, Krichavsky MZ, Balady GJ: Stress testing in patients with diabetes mellitus: Diagnostic and prognostic value. Circulation 2006;113:583-592.

symptoms nor evidence of cardiac or peripheral vascular disease, the ADA guidelines recommend testing for those who have two or more CV risk factors (i.e., dyslipidemia, hypertension, active smoking, family history of premature CAD, or albuminuria). Although the short-term prognosis (i.e., up to 2 years) in diabetic patients after a negative stress imaging test is excellent, multiple studies have found that those patients may suffer high late-event rates. This phe-

CAD, coronary artery disease; ECG, electrocardiogram; HDL, high-density lipoprotein; LDL, low-density lipoprotein. Adapted from Diagnosis and classification of diabetes mellitus. Diabetes Care 2006;29(Suppl 1):S43-S48.

nomenon is not seen in the nondiabetic population and is possibly the expression of rapid atherosclerosis progression and increased risk of plaque rupture. This observation has led some investigators to suggest that stress tests should be repeated every 2 years, although the value of such a strategy has not been studied.

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