Diabetes, Vol 44, Issue 5 543-549, Copyright © 1995 by American Diabetes Association

ARTICLES

Myocardial m-[123I]iodobenzylguanidine scintigraphy for the assessment of adrenergic cardiac innervation in patients with IDDM. Comparison with cardiovascular reflex tests and relationship to left ventricular function

G Kreiner, M Wolzt, P Fasching, T Leitha, A Edlmayer, A Korn, W Waldhausl and R Dudczak
Department of Medicine II, University of Vienna, Austria.

Cardiac imaging using m-[123I]iodobenzylguanidine (mIBG) reflects sympathetic myocardial innervation. In patients with insulin-dependent diabetes mellitus (IDDM), the following were studied: 1) the prevalence of derangements of cardiac autonomic innervation as detected by mIBG scintigraphy in comparison with cardiovascular reflex tests and 2) the relationship between adrenergic cardiac innervation and left ventricular (LV) function. Twenty-four patients with IDDM without overt heart disease were studied after silent coronary artery disease was excluded by 201Tl scintigraphy. Cardiac innervation was evaluated by both mIBG scintigraphy (tomographic imaging) and cardiovascular reflex tests. Systolic (ejection fraction [EF] percentage) and diastolic (peak filling rate [PFR] defined as end-diastolic volumes per second [EDV/s]) LV function were determined by equilibrium radionuclide angiography at rest and during bicycle exercise. mIBG scintigraphy was also performed in 10 control subjects. All control subjects exhibited a normal myocardial mIBG distribution. Among diabetic patients, only six had normal mIBG scans (group 1), whereas 18 had evidence of regional adrenergic denervation (group 2). Reflex tests suggested cardiac autonomic neuropathy in only seven of these patients (P < 0.01 vs. mIBG). All patients had a normal EF at rest. However, group 2 showed an impaired response to exercise as indicated by a smaller increase in EF (5 +/- 6 vs. 13 +/- 5%, P < 0.05) and a lower PFR (5.9 +/- 0.8 vs. 7.3 +/- 1.2 EDV/s, P < 0.01). Myocardial mIBG scintigraphy reveals that in patients with IDDM, sympathetic myocardial dysinnervation is much more common than previously thought. Furthermore, subclinical LV dysfunction is related to derangements of adrenergic cardiac innervation.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				Z. Y. Fang, J. B. Prins, and T. H. Marwick Diabetic Cardiomyopathy: Evidence, Mechanisms, and Therapeutic Implications Endocr. Rev., August 1, 2004; 25(4): 543 - 567. [Abstract] [Full Text] [PDF]

				K Foo, N Sekhri, A Deaner, C Knight, A Suliman, K Ranjadayalan, and A D Timmis Effect of diabetes on serum potassium concentrations in acute coronary syndromes Heart, January 1, 2003; 89(1): 31 - 35. [Abstract] [Full Text] [PDF]

				R. E. Schmidt, D. A. Dorsey, L. N. Beaudet, S. B. Plurad, C. A. Parvin, and M. S. Miller Insulin-like Growth Factor I Reverses Experimental Diabetic Autonomic Neuropathy Am. J. Pathol., November 1, 1999; 155(5): 1651 - 1660. [Abstract] [Full Text] [PDF]

				S. Braune, M. Reinhardt, R. Schnitzer, A. Riedel, and C. H. Lucking Cardiac uptake of [123I]MIBG separates Parkinson's disease from multiple system atrophy Neurology, September 1, 1999; 53(5): 1020 - 1020. [Abstract] [Full Text]

				M. F. Di Carli, D. Bianco-Batlles, M. E. Landa, A. Kazmers, H. Groehn, O. Muzik, and G. Grunberger Effects of Autonomic Neuropathy on Coronary Blood Flow in Patients With Diabetes Mellitus Circulation, August 24, 1999; 100(8): 813 - 819. [Abstract] [Full Text] [PDF]

				M. J. Stevens, D. M. Raffel, K. C. Allman, F. Dayanikli, E. Ficaro, T. Sandford, D. M. Wieland, M. A. Pfeifer, and M. Schwaiger Cardiac Sympathetic Dysinnervation in Diabetes : Implications for Enhanced Cardiovascular Risk Circulation, September 8, 1998; 98(10): 961 - 968. [Abstract] [Full Text] [PDF]