This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Albers, A. R. Articles by Balady, G. J. Search for Related Content PubMed PubMed Citation Articles by Albers, A. R. Articles by Balady, G. J. Related Collections Exercise testing Other diabetes Chronic ischemic heart disease

(Circulation. 2006;113:583-592.)
© 2006 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Stress Testing in Patients With Diabetes Mellitus

Diagnostic and Prognostic Value

Anne R. Albers, MD, PhD; Marc Z. Krichavsky, MD; Gary J. Balady, MD

From the Department of Medicine and the Section of Cardiology, Boston Medical Center, Boston University School of Medicine, Boston, Mass.

Correspondence to Gary J. Balady, MD, Section of Cardiology, Boston Medical Center, 88 E Newton St, Boston, MA 02118. E-mail gary.balady@bmc.org

Received August 20, 2005; revision received October 19, 2005; accepted October 25, 2005.

Key Words: stress testing • diabetes mellitus • exercise • imaging

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Exercise ECG and stress imaging tests are used for diagnostic and prognostic purposes and to monitor the effects of therapeutic interventions.^1,2 Such testing is most often applied to individuals with known or suspected coronary artery disease (CAD), and its value has been well studied.¹ CAD is more severe, more prevalent, and occurs at a younger age in patients with diabetes mellitus (DM). Diabetic patients without known CAD have similar rates of subsequent myocardial infarction (MI) compared with nondiabetic patients with a previous MI.³ Accordingly, DM is considered a risk equivalent to established CAD, and national guidelines for treatment of cardiac risk factors recommend similar goals for diabetic patients and those with known CAD.^4–8 Diabetic patients have significantly higher rates of silent ischemia than the general population, and it has been postulated that this contributes to more advanced CAD on initial presentation and worse outcomes in diabetic patients.⁹ Because of this altered natural history, investigators have evaluated stress testing and its diagnostic and prognostic value among patients with DM. In particular, the utility of stress testing among asymptomatic diabetic patients remains an area of active study.

The following article seeks to review the diagnostic and prognostic value of exercise ECG and stress imaging tests in symptomatic and asymptomatic patients with DM. Additionally, it aims to identify gaps in the current literature and summarize what recommendations can be made from the available data. PubMed and Medline 1966 through June 2005 databases were searched to identify all studies that addressed stress testing primarily . . . [Full Text of this Article]

This article has been cited by other articles:

				P. M. Ho, T. M. Maddox, C. Ross, J. S. Rumsfeld, and D. J. Magid Impaired Chronotropic Response to Exercise Stress Testing in Patients With Diabetes Predicts Future Cardiovascular Events Diabetes Care, August 1, 2008; 31(8): 1531 - 1533. [Abstract] [Full Text] [PDF]

				E. Roelker Screening for Coronary Artery Disease in Patients With Diabetes Diabetes Spectr, July 1, 2008; 21(3): 166 - 171. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden Cardiovascular Disease in Diabetes Diabetes Care, June 1, 2008; 31(6): 1260 - 1266. [Full Text] [PDF]

				A. I. Vinik and D. Ziegler Diabetic Cardiovascular Autonomic Neuropathy Circulation, January 23, 2007; 115(3): 387 - 397. [Full Text] [PDF]

				Y. S. Ali and D. J. Maron Screening for Coronary Disease in Diabetes: When and How Clin. Diabetes, October 1, 2006; 24(4): 169 - 173. [Abstract] [Full Text] [PDF]