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Exercise testing, clinical, and angiographic characteristics of anginal patients with and without diabetes mellitus
Insights
Diabetes mellitus (DM) in patients with coronary artery disease (CAD) leads to earlier onset of anginal pain during exercise and reduced exercise duration. These findings suggest DM exacerbates cardiac pathophysiology beyond CAD alone.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- The impact of diabetes mellitus (DM) on the clinical presentation and pathophysiology of CAD requires further elucidation.
Purpose of the Study:
- To investigate the influence of coexisting diabetes mellitus (DM) on the clinical and pathophysiologic characteristics of patients with coronary artery disease (CAD).
Main Methods:
- A cohort of 1,211 patients undergoing coronary angiography (CAG) was reviewed.
- Eighty patients with significant CAD but without other cardiac conditions underwent symptom-limited treadmill testing (TM) and CAG.
- Patients were categorized into those with DM (n=22) and without DM (NDM, n=58).
Main Results:
- No significant differences were observed in the number of diseased arteries or left ventricular ejection fraction between DM and NDM groups.
- Exercise-induced ST depression and anginal pain incidence did not differ between groups.
- DM patients exhibited shorter mean exercise duration (345 sec vs. 423 sec) and earlier onset of anginal pain (187 sec vs. 248 sec) compared to NDM patients.
- Heart rate responsiveness to exercise was higher in DM patients.
Conclusions:
- Coexisting diabetes mellitus in CAD patients is associated with reduced exercise capacity and earlier anginal symptoms.
- These findings suggest that DM contributes to cardiac pathophysiology in CAD patients, potentially through direct myocardial damage.
- Further research is warranted to understand the complex interplay between DM and CAD.
Abstract:
To elucidate the influence of coexisting diabetes mellitus (DM) on clinical and pathophysiologic characteristics in patients with coronary artery disease (CAD), the authors reviewed 1,211 consecutive patients who underwent coronary angiography (CAG) and selected 80 patients with significant CAD but without myocardial infarction, hypertension, or other heart diseases, who underwent both symptom-limited treadmill test (TM) and CAG within four weeks. DM was found in 22 of the 80 patients. No significant difference in the average number of diseased arteries of left ventricular ejection fraction at rest was found between DM patients and patients without DM (NDM patients). The incidences of exercise-induced ST depression and anginal pain revealed no difference between DM and NDM patients. Mean duration of exercise was shorter in DM patients (345 +/- 97 sec) than in NDM patients (423 +/- 162 sec, p less than 0.01). Furthermore, anginal pain during exercise occurred earlier in DM patients (187 +/- 68 sec) than in NDM patients (248 +/- 99 sec, p less than 0.05). No significant difference in double product or magnitude of ST segment depression at the onset of anginal pain was found between DM and NDM patients. However, heart rate responsiveness to exercise in DM patients was higher than that in NDM patients. These findings may indicate that pathophysiology of the heart in CAD patients with DM is affected not only by CAD itself but also by myocardial damage due to DM.