PMID- 34790709
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240404
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 8
DP  - 2021
TI  - Screening for Asymptomatic Coronary Artery Disease via Exercise Stress Testing in 
      Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.
PG  - 770648
LID - 10.3389/fcvm.2021.770648 [doi]
LID - 770648
AB  - Objectives: This meta-analysis aims to investigate the diagnostic value of 
      exercise stress testing (EST) for asymptomatic coronary artery disease (CAD) 
      among patients with type 2 diabetes mellitus (T2DM) and to ascertain the 
      influence of different variables on the sensitivity and specificity of EST. 
      Background: Asymptomatic CAD occurs in >1 in five diabetes mellitus patients, and 
      it is associated with an increased risk of complications. Methods for screening 
      asymptomatic CAD in T2DM patients are still not unified. Methods: MEDLINE (via 
      Ovid), Embase (via Ovid), Cochrane Library, SCOPUS, PubMed, Ovid, EBSCO ASP, and 
      Web of Science were systematically searched on June 8 and 9, 2021, for diagnostic 
      cohort and case-control studies. We included studies that used EST to screen for 
      CAD in asymptomatic patients with T2DM, and that used coronary angiography to 
      diagnose CAD and had reported the basic diagnostic indicators. The Quality 
      Assessment of Diagnostic Accuracy Studies 2 tool was used to assess study 
      quality. The combined effect sizes were calculated by overall analysis and 
      multiple variable effects were explored by regression analysis and subgroup 
      analysis. Results: Nine groups of data from eight diagnostic cohort studies, 
      totaling 515 participants, were included. Included studies showed a low risk of 
      bias in most items, except for flow and timing. The combined sensitivity and 
      specificity of EST for asymptomatic CAD in patients with T2DM were 55 (48 to 61%) 
      and 66 (61 to 70%), respectively. When non-diagnostic tests were excluded, 
      sensitivity increased to 73 (56 to 88%). The proportion receiving angiography 
      also significantly affected sensitivity. No significant difference was found in 
      the duration of diabetes or other additional risk factors. Conclusions: EST is a 
      tool of moderate sensitivity and specificity to be used for the initial screening 
      of asymptomatic CAD in T2DM. It has the advantage of being non-invasive, 
      relatively inexpensive, easily available in most settings, and has no radiation 
      associated with its use. Additional research with higher quality studies in which 
      tests that are non-diagnostic are included and flow and timing is described 
      clearly, will be important to further our understanding of EST for asymptomatic 
      CAD detection in patients with T2DM. Systematic review registration: PROSPERO 
      CRD42021259555.
CI  - Copyright (c) 2021 Dun, Wu, Cui, Thomas, Olson, Zhou, Li and Liu.
FAU - Dun, Yaoshan
AU  - Dun Y
AD  - Division of Cardiac Rehabilitation, Department of Physical Medicine & 
      Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.
AD  - National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital of 
      Central South University, Changsha, China.
AD  - Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo 
      Clinic, Rochester, MN, United States.
FAU - Wu, Shaoping
AU  - Wu S
AD  - Division of Cardiac Rehabilitation, Department of Physical Medicine & 
      Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.
FAU - Cui, Ni
AU  - Cui N
AD  - Division of Cardiac Rehabilitation, Department of Physical Medicine & 
      Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.
FAU - Thomas, Randal J
AU  - Thomas RJ
AD  - Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo 
      Clinic, Rochester, MN, United States.
FAU - Olson, Thomas P
AU  - Olson TP
AD  - Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo 
      Clinic, Rochester, MN, United States.
FAU - Zhou, Nanjiang
AU  - Zhou N
AD  - Division of Cardiac Rehabilitation, Department of Physical Medicine & 
      Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.
FAU - Li, Qiuxia
AU  - Li Q
AD  - Division of Cardiac Rehabilitation, Department of Physical Medicine & 
      Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.
FAU - Liu, Suixin
AU  - Liu S
AD  - Division of Cardiac Rehabilitation, Department of Physical Medicine & 
      Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.
AD  - National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital of 
      Central South University, Changsha, China.
LA  - eng
PT  - Systematic Review
DEP - 20211101
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC8591186
OTO - NOTNLM
OT  - coronary artery disease (CAD)
OT  - diagnostic test
OT  - exercise stress testing (EST)
OT  - meta-analysis
OT  - type 2 diabetes mellitus(T2DM)
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/11/19 06:00
MHDA- 2021/11/19 06:01
PMCR- 2021/01/01
CRDT- 2021/11/18 07:02
PHST- 2021/09/04 00:00 [received]
PHST- 2021/10/08 00:00 [accepted]
PHST- 2021/11/18 07:02 [entrez]
PHST- 2021/11/19 06:00 [pubmed]
PHST- 2021/11/19 06:01 [medline]
PHST- 2021/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2021.770648 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2021 Nov 1;8:770648. doi: 10.3389/fcvm.2021.770648. 
      eCollection 2021.