Exercise Testing, Clinical, and Angiographic Characteristics of Anginal Patients With and Without Diabetes Mellitus

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.