title: Exercise treadmill test in detecting asymptomatic coronary artery disease in type 2 diabetes mellitus.
abstract: 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%.
  
  
  CONCLUSIONS
  In the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes ≥10 years.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea.
authors.forename: Mee Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Ki Hyun
authors.initials: KH
authors.lastname: Baek
authors.forename: Ki Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Hyuk Sang
authors.initials: HS
authors.lastname: Kwon
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Moo Il
authors.initials: MI
authors.lastname: Kang
authors.forename: Kun Ho
authors.initials: KH
authors.lastname: Yoon
authors.forename: Bong Yun
authors.initials: BY
authors.lastname: Cha
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Son
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Lee