Diagnostic usefulness of the post-exercise systolic blood pressure response for the detection of coronary artery disease in patients with diabetes mellitus

Patients with diabetes mellitus (DM) often have a positive result on exerci se testing despite a normal coronary arteriogram, which indicates that exer cise-induced ST depression is not always an accurate indicator of the prese nce of coronary artery disease (CAD) in such patients. The present study ev aluated the usefulness of the post-exercise systolic blood pressure (SBP) r esponse for the detection of CAD in 47 consecutive patients with DM. Signif icant stenotic lesions were detected by angiography in 25 patients; 18 of t hese had true positive (TP) exercise testing results, and 7 had false negat ive (FN) results, No significant stenotic lesions were detected in the rema ining 22 patients and of these 10 had true negative (TN) exercise testing r esults, and 12 had false positive (FP) results. The SBP ratio (SBP after 3 min of recovery divided by the SBP at peak exercise) was significantly high er in patients with coronary stenoses than in those without. Analysis of th e relative cumulative frequency revealed that a SBP ratio greater than 0.87 was associated with significant stenoses. The sensitivity, specificity, an d accuracy of ST change combined with a SBP ratio greater than 0.87 for det ecting stenoses in patients with DM were 68%, 82%, and 74%, respectively. T hese results suggest that calculating the SBP ratio, in combination with mo nitoring for ST depression, improves the accuracy of treadmill exercise tes ting for the detection of CAD in patients with DM.