Sixty-nine type I diabetic patients who had no symptoms suggestive of coronary artery disease and who
were unselected with respect to other coronary risk factors were studied to determine the physiologic and prognostic
implications of rest and exercise radionuclide ventriculographic testing. During a median follow-up interval of 29
months (interquartile range 22-39 months) 11 patients developed clinical coronary artery disease consisting of fatal
myocardial infarction, sudden cardiac death, or angina pectoris with coronary artériographie documentation of at
least one >50% luminal diameter coronary artery stenosis. Multivariate analysis of clinical and exercise variables
identified the peak exercise heart rate, exercise duration, and the exercise left ventricular ejection fraction as independent
predictors of subsequent clinical coronary disease. Ninety-seven percent of diabetic patients with a normal
rest and exercise radionuclide ventriculogram remained free of clinical evidence of coronary artery disease during 29
months of follow-up, whereas 40% of patients with an abnormal radionuclide study developed clinical disease. In
this asymptomatic diabetic population that was unselected with respect to coronary risk factors, correlative coronary
angiographic and exercise 201TI scintigraphic studies suggested that the coronary arteries were not normal in the
majority of patients with evidence of left ventricular dysfunction with exercise by radionuclide ventriculography.
Chest pain limited to the postexercise recovery period is an uncommon symptom, the clinical correlates
of which have not been previously reported. Therefore, 25 patients with chest pain limited to the postexercise
recovery period were compared to 25 patients with chest pain during treadmill exercise testing and to 25 patients
with no chest pain during exercise or recovery. Patients with chest pain during exercise or recovery had more
extensive angiographic coronary disease compared to patients without chest pain. In study patients with pain during
recovery from exercise, ST-segment depression on the exercise electrocardiogram was highly predictive for the
presence of coronary artery disease (p < 0.01). For patients with chest pain limited to the recovery period, the
rate-pressure product was significantly lower at the time of onset of chest pain compared to the time of peak exercise
(16,589 ± 6,877 versus 24,039 ± 8,020, p < 0.05). The latter findings suggest that chest pain first appearing during
recovery from exercise may not be a direct result of increased myocardial oxygen demand.
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