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Muntaha Irshad
Komal Arzoo
Murad Baig
Ali Raza Sandhu
Zubia Begum
Soban Abu Khifs
Kamel J. K. Walwil
Jumana Abdelrahman Diab
Hosam Alazazzi
Akashnath Kivalur Ganeshanath
Saifullah Syed


Coronary artery disease, Duke Treadmill score, Diabetic patients


Background and Aim: The coronary artery disease risk stratification can be done with established clinical tool Duke Treadmill Score (DTS). The present study aimed to investigate the role of Duke Treadmill Score in predicting the severity of coronary artery disease in diabetic vs. non-diabetics.

Patients and Methods: This prospective study was conducted on 100 diabetic and 100 non-diabetic patients in the Cardiology Department of Tertiary Care Hospital of Pakistan from January 2020 to December 2022. All the diabetic patients with blood sugar level >126 mg/dL were enrolled. Standard Bruce protocol was used for measuring the exercise stress tests.  ST-T changes, rate, and rhythm were monitored by an electrocardiogram (ECG). Exercise test was terminated based on chest pain, ST depression N3 mm, ventricular tachycardia, excessive increase (>230 mm Hg), and limiting symptoms (such as dyspnea and dizziness). Data analysis was done using SPSS version 27.  

Results: The overall mean age of diabetic and non-diabetic was 58±9.6 years and 58±9.7 years respectively. There were 112 (56%) male and 88 (44%) female. Hypertension, current smoking, and Hypercholesterolemia were different risk factors found (64% vs. 44%), (15% vs. 20%), and (21% vs 26%) respectively. Survival free from congestive heart failure, cardiac death, and nonfatal myocardial infarction was 15%, 87%, and 52% respectively in low to high-risk diabetic patients and 19%, 90%, and 55% respectively in nondiabetics. Coronary angiography and secondary events were more in diabetic groups than non-diabetic during follow-up. The severity of coronary artery disease was assessed using DTS in both diabetics and non-diabetics.

Conclusion: The DTS alone is an effective method for detecting a significant coronary artery. The DTS is an accurate predictor of CAD. Based on clinical data, individuals should be treated for DTS group intermediate risk outcome using exercise tests. 

Abstract 182 | pdf Downloads 46


1. Mirbolouk F, Salari A, Pourbahador R, Gholipour M, Pourtahmasbi A. Relationship Between Duke Treadmill Score and Severity of CAD in Suspected Patients. Acta Medica Iranica. 2022.
2. Turhan Caglar FN, Gok G, Oztimer G, Katkat F, Karakozak D, Oztas DM, Beyaz MO, Ugurlucan M. Addition of the duration of ST segment depression to Duke treadmill score for diagnostic accuracy of exercise electrocardiography to predict obstructive coronary artery disease. Acta Cardiologica. 2022 Jul 3;77(6):494-500.
3. Arif M, Butt MA. Exercise tolerance test using duke treadmill: An observational study in a private tertiary care hospital. Journal of Clinical and Preventive Cardiology. 2021 Apr 1;10(2):68-.
4. Ahmad S, Ali A. Correlation of Duke Treadmill Score with Coronary angiographic Findings in Patients with Stable Ischemic Heart Disease. Pakistan Journal of Medical & Health Sciences. 2023 Mar 29;17(03):122-.
5. Salama MA, Elgamaal MS, Sadek AE, Hafez AY. Value of Duke treadmill score in setting priority of patients for coronary angiography. The Egyptian Journal of Hospital Medicine. 2019 Jul 1;76(4):3933-9.
6. Koh AS, Gao F, Chin CT, et al. Differential risk reclassification improvement by exercise testing and myocardial perfusion imaging in patients with suspected and known coronary artery disease. J Nucl Cardiol. 2016; 23(3): 366–378, doi: 10.1007/s12350-015-0253-x, indexed in Pubmed: 26358085.
7. Günaydın ZY, Bektaş O, Gürel YE, et al. The value of the Duke treadmill score in predicting the presence and severity of coronary artery disease. Kardiol Pol. 2016; 74(2): 127–134, doi: 10.5603/KP.a2015.0143, indexed in Pubmed: 26202537
8. Muhammad A, Rehana K, Tahir I, Hafiz MS, Mir WB, Samra R, et al. Role of Duke Treadmill Score in assessing the severity of coronary artery disease in patients presenting with angina.Pak Armed Forces Med J 2018; 68 (Suppl-1): S147-S52.
9. Mohsen AS, Mohamed SE, AymenES, Ahmed YH. Value of Duke treadmill score in setting priority of patients for coronary angiography. Egypt J Hosp Med 2019; 76(4): p.3933-9
10. Vilma D, Virginijus S, Vytautas K, Egidija R, Rima S, Ruta E, et al. Value of Duke treadmill score in predicting coronary artery lesion and the need for revascularization. Kardiol Pol 2017; 75(5): p. 439–44.
11. Alam MM, Rahman MM, Parvin T, Al-Amin M, Khaled MF, Bajracharya P, et al. Simple Treadmill Score: Does It Have Better Predictability for Coronary Artery Disease?.MMed J. 2022;31(2):p. 490-7.
12. El KershAM, Abdo El deeb HM, Mohamed Yousof AM. The Prognostic Value of Duke Treadmill Score in Prediction of MPI Result. Europ Heart J. 2022;24(SuppG):suac049-010.
13. Nasution MK, Siregar AA, Hasan H, Mukhtar Z, Raynaldo AH, Akbar N. Addition of risk factors of coronary heart disease in diagnostic value of treadmill score for detecting complexity ofcoronary arterial lesions. Acta Card Ind. 2018;4(2):p. 88.
14. Salokari E, Laukkanen JA, Lehtimaki T, Kurl S, Kunutsor S, Zaccardi F, et al. The Duke treadmill score with bicycle ergometer: Exercise capacity is the most important predictor of cardiovascular mortality. Europ J PrevenCardiol. 2019;26(2):p. 199-207.
15. Zaman M, Fatima N, Zaman A, Zaman U, Tahseen R, Zaman S. Higher event rate in patients with high-risk Duke Treadmill Score despite normal exercise-gated myocardial perfusion imaging. World J Nuclear Med. 2018;17(03):p. 166-70.
16. Rubiyaktho D, Tjahjono CT. Comparison of Predicted Significant Coronary Lesion by Duke Treadmill Score among Coronary Heart Disease Risk Factors in Patients with Positive Ischemic Response Treadmill Test. Acta Card Ind.2018;4(1):p. 1-8.
17. Nakas G, Bechlioulis A, Marini A, Vakalis K, Bougiakli M, Giannitsi S, et al. The importance of characteristics of angina symptoms for the prediction of coronary artery disease in a cohort of stable patients in the modern era. Hellenic J Cardiol. 2019;60(4):p. 241-6.
18. Sundqvist P, Pikkarainen E, Rautava P, Majaluoma S, Korhonen PE. Yield of elective coronary angiography; gender differences, patient history, risk factors and angiographic findings in a primary carepopulation. Scand J Prim Health Care. 2020;38(4):p. 481-6.
19. Gao Z, Chen Z, Sun A, Deng X. Gender differences in cardiovascular disease. Med in Novel Tech and Dev. 2019;4:100025.
20. Battram T, Hoskins L, Hughes DA, Kettunen J, Ring SM, Smith GD, et al. Coronary artery disease, genetic risk and the metabolome in young individuals. Wellcome Open Res 2019;3:114.
21. Tuso P, Stoll SR, Li WW. A plant-based diet, atherogenesis, and coronary artery disease prevention. Perm J 2015 Winter;19:62-7.
22. Zoet GA, Benschop L, Boersma E, Budde RP, Fauser BC, Van Der Graaf Y,et al. Prevalence of subclinical coronary artery disease assessed by coronary computed tomography angiography in 45-to 55-year-old women with a history of preeclampsia. Circulation 2018;137:877-9.
23. Ali SN, Shehzad A, Qureshi BA, Hashmi KA. Pattern of angiographic findings in patients with stable angina having high risk duke score on exercise testing. Pak Heart J 2016;49.
24. Asad M, Khadim R, Iqbal T, Shafique HM, Baloch MW, Rehmat S,et al. Role of Duke Treadmill score in assessing the severity of coronary artery disease in patients presenting with angina. Pak Armed Forces Med J 2018;68:147-52.
25. Uçar H, Gür M, Börekçi A, Yıldırım A, Baykan AO, KalkanGY,et al. Relationship between extent and complexity of coronary artery disease and different left ventricular geometric patterns in patients with coronary artery disease and hypertension. Anatol J Cardiol2015;15:789-94

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