Vnitr Lek 1999, 45(9):545-549

[The stress ergometry test in diabetics and non-diabetics].

V Bartůnková, L Bartůněk: Lécebné lázně Konstantinovy Lázně a.s.

OBJECTIVE: Evaluate risk factors of ischaemic heart disease (IHD) and the importance of burdening on a bicycle ergometer (BE) in the diagnosis of IHD in diabetic and non-diabetic subjects. CHARACTERISTIC OF GROUP: The authors evaluated in a retrospective study all 308 patients subjected to BE during the period 11/98-1/99 in Konstantinovy Láznĕ. Characteristics of diabetic vs. non-diabetic subjects: number (97 vs. 211), men (70.1 vs. 70.14%) mean age (59.76 vs. 58.01), height (1.71 vs. 1.71 m), body weight (85.91 vs. 81.40 kg), BMI (29.36 vs. 27.68 g/m2), total cholesterol (5.73 vs. 5.51 mmol/l,) triacylglycerols (2.63 vs. 2.08 mmol/l), fasting blood sugar level (7.31 vs. 4.88 mmol/l), hypertension (24.74 vs. 37.44%), hyperuricaemia (40.21 vs. 27.01%), IHD (93.81 vs. 93.84%), ischaemia of the lower extremities (6.19 vs. 13.74%), cerebrovascular episodes (7.22 vs. 5.21%), smokers 10.31 vs. 5.21%), ex-smokers (47.42 vs. 57.82%), non-smokers (42.27 vs. 36.97%). The diabetic patients were treated in 31.96% with PAD, in 5.15% with insulin and in 62.89% by diet only.
EVALUATION: BE was used to assess and set the load tolerance, i.e. with regard to the current medication. The conclusion of BE is from the aspect of IHD either positive (ECG signs of coronary insufficiency), negative (without signs of coronary insufficiency at the level of 85% aerobic capacity according to Astrand) or impossible to evaluate (without signs of coronary insufficiency, while not attaining this level of load). Positive ergometric examinations were divided into symptomatic ones (i.e. with stenocardias during BE) and asymptomatic (silent ischaemia). In diabetic vs. non-diabetic subjects there were 0% vs. 6.16% symptomatically positive BE, 27.84% vs. 11.37% positive BE with silent ischaemia, 17.53% vs. 20.85% negative BE and 54.64% vs. 61.61% BE which could not be evaluated. The watt training tolerance was 51.55 vs. 57.26 W.

CONCLUSIONS: In diabetics (31.49% of the group) there was a significantly higher body weight, BMI, TG. As to risk factors of IHD and manifestations of atherosclerosis there were among diabetics more patients with a history of a cerebrovascular episode, more smokers and conversely fewer hypertonic subjects and fewer with ischaemia of the lower extremities than in non-diabetic subjects. During BE in diabetics there were more silent ischaemias than in non-diabetics. None of the diabetics with a positive BE suffered from symptomatic ischaemia. The high percentage of BE which cannot be evaluated in both groups is due to the concurrent administration of drugs, in particular beta-blockers and the protocol of the examination (an increasing loading test after 4 min. á 25 W) which is suitable for setting the training load and not for assessment of coronary insufficiency (for this purpose the protocol after 2 min. á 50 W is more suitable). In the conclusion the authors evaluate the importance and informative value of different diagnostic examinations for detection of IHD or its severity in diabetic and non-diabetic subjects.