Abstract
Object: Exercise tolerance testing, or ETT, is an effective instrument to diagnose which patients have ischemia when activity impacts their electrocardiograms. It can also be used to collect significant information about exercise capacity, exercise-induced arrhythmias, blood pressure and heart rate responses, and symptoms.
Aims: To determine the severity and complexity of CAD, a complete angiographic scoring system is employed intermittently called SYNTAX score. The association between Syntax score and CAD severity in patients with diabetes mellitus is not well-researched in the background.
Methodology: Patients with diabetes who were thought to have coronary artery disease received exercise tolerance testing. Syntax score was used to evaluate positive cases undergoing coronary angiography in order to predict the association. In the cardiology department of the Ibrahim Cardiac Hospital and Research Institute in Dhaka, observational research was performed. Bangladesh, between June 1, 2020, to November 30, 2023. Based on their Duke tread mill scores, 520 patients were included in this study and separated into groups. Diabetic patients with high Duke Treadmill score (DTS) (≤-11) were included in group I and diabetic patients with medium ( -10 to +4) and low Duke Treadmill score (≥+ 5) were included in group II.
Results: Throughout June 1, 2020, and November 30, 2023 in the cardiology department of the Ibrahim Cardiac Hospital and Research Institute in Dhaka, observational research was performed, Bangladesh. There were 520 patients studied and grouped according to their Duke treadmill scores. The mean age of study population was 55.2 ± 9.0 years, ranging from 18 to 75 years. Triple vessel disease patients exhibited a statistically significant (p=0.001) higher SYNTAX score > 22 than SYNTAX score < 22. The probability of developing severe coronary artery disease (SYNTAX score > 22) is more than 5.0 (95% CI = 3.7-7.6) times higher for diabetic patients with DTS < -11 (high-risk group) than for those with DTS ≥ -10 (low & medium risk) (p < 0.001). The considerable adverse relationship among the DTS and SYNTAX scores is evident (r = - 0.583, p 0.0001).
Conclusion: High DTS was found to be strongly connected with the coronary artery disease severity by calculating SYNTAX score. Patients with high Duke Treadmill scores are at increased risk of cardiovascular disease.
References
Lin X, Xu Y, X P, Jingya Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Nature. 2020;10:14790.
Baena-Díez JM, Peñafiel J, Subirana I, Ramos R, Elosua R, Marín-Ibañez A, et al. Risk of cause-specific death in individuals with diabetes: a competing risks analysis. Diabetes Care. 2016;39:1987-95.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice. 2019;157:107843.
International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels. Belgium: 2019. Available at: https://www.diabetesatlas.org, accessed 18 November 20202019
Albers AR, Krichavsky MZ, Balady GJ. Stress testing in patients with diabetes mellitus: diagnostic and prognostic value. Circulation. 2006; 113:583–92. [PubMed: 16449735] .
Lauer MS, Pothier CE, Magid DJ, Smith SS, Kattan MW. An externally validated model for predicting long-term survival after exercise treadmill testing in patients with suspected coronary artery disease and a normal electrocardiogram.Ann Intern Med. 2007 Dec 18;147(12):821-8. doi: 10.7326/0003-4819-147-12-200712180-00001.PMID: 18087052
Mark DB, Shaw L, Harrell FE, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. New England Journal of Medicine. 1991; 325(12):849– 53. [PubMed: 1875969]
Goldschlager N et al.Use of the treadmill test in the diagnosis of coronary artery disease in patients with chest pain. Ann Intern Med.. 1982 Sep;97(3):383-8. doi: 10.7326/0003-4819-97-3-383.
Neiman K ,Galema T,Weustink A, N eefjesL,Moelker A, Musters P et al.Computd Tomography versus excersice electrocardiography in patients with stable chest complaints :real world experiances from a fast track chest pain clinic.Heart.2009 ;95 :1669-1675
Detrano R, Gianrossi R, Froelicher V. The diagnostic accuracy of the exercise electrocardiogram: a meta-analysis of 22 years of research. Prog Cardiovasc Dis 1989; 32: 173-206.
Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta analysis. Circulation 1989; 80: 87-98.
Fardin M, Arsalan S, Reza P et al. Relationship Between Duke Treadmill Score and Severity of CAD in Suspected Patients. Acta Med Iran 2022;60(11):714-719.
Günaydın ZY, Bektaş O, Gürel YE, Karagöz A, Kaya A, Kırış T, Zeren G, Yazıcı S. The value of the Duke treadmill score in predicting the presence and severity of coronary artery disease. Kardiol Pol. 2016;74(2):127-34. doi: 10.5603/KP.a2015.0143. Epub 2015 Jul 23.).
Acar Z,. Korkmaz L, Agac MT, Erkan H, Dursun I, Kalaycioglu E, Kiris G, Celik S ,Relationship Between Duke Treadmill Score and Coronary Artery Lesion Complexity. Clin Invest Med 2012; 35 (6): E365-E369.
Shehzad A, Asif A et al. Correlation of Duke Treadmill score with Coronary angiographiuc Findings in Patients with Stable Ischemic Haert Disease. PJMHS March 2023 ; Vol. 17 :p122-123.DOI ; https://doi.org/1053350/pjmhs2023173122.
Taimur SDM,Khan SR,Islam F Angiographic evaluation of ETT positive patients in tertiary care hospital of Bangladesh.IJMHS2014 ;vol ;08(2) ;834-838.
David R, Cholid T T et al. Comparison of predicted Significant coronary lesion by Duke Tread mill Score among Coronary heart disease risk factors in Patients with positive ischemia response Treadmill test. Acta Cardiologia Indonesiana. 2018;vol.04:No.01:p1-8.
Blankstein R, Ahmed W, Bamberg F et al. Comparison of exercise treadmill testing with cardiac computed tomography angiography among patients presenting to the emergency room with chest pain.Circ Cardiovasce Imaging 2012;5: 233-242.
Sadik VE Rahman BG,Oktay S,Ugur K,Ersin CS et al. Decease Heart rate recover may predict a high SYNTAX Score in patients with Stable Coronary artery diseased.Bosn J Basic Med SCi.2019 ;19(1) :109-1.
Premsagar P , Aldous C, Esterhuizen T . The value of exercise stress testing in prediction of angiography amongst South African patients using quantitative scoring systems. SAHeart 2021;18:96-105.
