Screening for Asymptomatic Coronary Artery Disease via Exercise Stress Testing in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.
Screening for Asymptomatic Coronary Artery Disease via Exercise Stress Testing in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.
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DOI：
10.3389/fcvm.2021.770648
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发表时间：
2021
影响因子：
3.6
通讯作者：
Liu S
中科院分区：
文献类型：
--
作者：
Dun Y;Wu S;Cui N;Thomas RJ;Olson TP;Zhou N;Li Q;Liu S
目的：本荟萃分析旨在探讨运动负荷试验（EST）对2型糖尿病（T2 DM）患者无症状冠状动脉疾病（CAD）的诊断价值，并确定不同变量对EST敏感性和特异性的影响。背景：无症状性CAD发生率>1/5的糖尿病患者，并且与并发症风险增加相关。T2 DM患者中无症状CAD的筛查方法仍不统一。研究方法：于2021年6月8日和9日系统检索MEDLINE（via奥维德）、Embase（via奥维德）、科克伦Library、SCOPUS、PubMed、奥维德、EBSCO ASP和Web of Science，查找诊断队列和病例对照研究。我们纳入了使用EST在无症状T2 DM患者中筛查CAD的研究，以及使用冠状动脉造影诊断CAD并报告了基本诊断指标的研究。使用诊断准确性研究2的质量评估工具评估研究质量。采用总体分析计算联合效应量，采用回归分析和亚组分析探讨多变量效应。结果：共纳入8项诊断性队列研究的9组数据，共计515例受试者。纳入的研究显示，除流量和时间外，大多数项目的偏倚风险较低。EST对T2 DM患者无症状CAD的联合敏感性和特异性分别为55（48 - 61%）和66（61 - 70%）。当排除非诊断性测试时，敏感性增加到73（56%至88%）。接受血管造影的比例也显著影响敏感性。在糖尿病的持续时间或其他额外的风险因素方面没有发现显着差异。结论：EST是一种中等敏感性和特异性的工具，可用于T2 DM患者无症状CAD的初步筛查。它的优点是无创，相对便宜，在大多数情况下容易获得，并且没有与其使用相关的辐射。包括非诊断性检查并明确描述流程和时间的更高质量研究的额外研究对于进一步了解EST用于T2 DM患者无症状CAD检测非常重要。系统综述注册：PROSPERO CRD 42021259555。
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.
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影响因子：
14
作者：
Budoff, Matthew J.;Raggi, Paolo;Soman, Prem
通讯作者：
Soman, Prem
影响因子：
6.2
作者：
Hermann, Luke K.;Weingart, Scott D.;Henzlova, Milena J.
通讯作者：
Henzlova, Milena J.
影响因子：
--
作者：
MANSON, JE;COLDITZ, GA;HENNEKENS, CH
通讯作者：
HENNEKENS, CH
DOI：
10.1080/00365510601045088
发表时间：
2007-01-01
影响因子：
2.1
作者：
Johansen, O. E.;Birkeland, K. I.;Gullestad, L.
通讯作者：
Gullestad, L.
影响因子：
3.6
作者：
Dun Y;Olson TP;Ripley-Gonzalez JW;Xie K;Zhang W;Cai Y;Liu Y;Shen Y;Zhou N;Gong X;Liu S
通讯作者：
Liu S