Heart rate adjustments and analysis of recovery patterns of ST-segment depression in type 2 diabetes.
OBJECTIVE
To investigate the diagnostic value for coronary artery disease (CAD) detection of evaluating time- and heart rate (HR)-related ST-segment changes (the ST/HR-slope) and the post-exercise recovery pattern (the ST/HR-recovery loop) in patients with type 2 diabetes mellitus (T2DM).


RESULTS
Ninety-one patients (22 female, age 59+/-9 years) with T2DM (diabetes duration 6+/-6 years) performed an exercise ECG-test that was evaluated using the ST/HR slope (cut-off</=-2.4 microV/bpm) and -recovery loop patterns (abnormal versus normal) and compared to the conventional >/=1 mm ST-segment depression criterion and dobutamine stress echo-cardiography, all evaluated against coronary angiography irrespective of stress test results. Coronary angiography revealed CAD in 20 men and 3 women (25%). Sensitivity for the conventional exercise test and stress echocardiography was low (0.35 and 0.30), but increased significantly using the ST/HR-slope (0.45), the recovery loop (0.86) or the combined ST/HR slope and recovery loop criterion (0.91). The associations between angiographic CAD-detection and the different tests expressed by the Odds ratio demonstrated an added value of performing ST/HR analysis both over pre-test CAD risk profile and the established techniques.


CONCLUSIONS
T2DM patients capable of performing an exercise test could be assessed with the ST/HR-analysis for selecting patients to angiography. However, further studies including a higher number of patients are needed to confirm the diagnostic value of this approach.
Johansen
Odd Erik
OE
Bjurö
Thorvald
T
Endresen
Knut
K
Blaasaas
Karl G
KG
Birkeland
Kåre
K
Aakhus
Svend
S
Gullestad
Lars
L
D000704:Analysis of Variance; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged