Scintigraphic evidence for cardiac sympathetic dysinnervation in long-term IDDM patients with and without ECG-based autonomic neuropathy.
To analyse the presence and extent of global and regional distributions of cardiac sympathetic dysinnervation in long-term insulin-dependent diabetes mellitus (IDDM) without myocardial perfusion abnormalities (99mTc-methoxy isobutyl isonitrile study), 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy was performed in two clinically-comparable groups (20 diabetic patients with and 22 diabetic patients without ECG-based cardiac autonomic neuropathy). For comparison nine control subjects without heart disease were investigated. Only six diabetic patients (27%) without and one diabetic patient (5%) with ECG-based autonomic neuropathy were found to have a uniform homogeneous uptake of 123I-MIBG, in contrast to a uniform homogeneous uptake in all control subjects. The uptake of 123I-MIBG in the posterior myocardium of diabetic patients was smaller than in the anterior, lateral and septal myocardium (p < 0.001, p < 0.001, p = 0.001). In addition, diabetic patients with cardiac autonomic neuropathy (> or = two of five age-related cardiac reflex tests abnormal) demonstrated a more reduced uptake in the global, lateral and posterior myocardium than diabetic patients without (p < 0.01, p < 0.01, p < 0.001). A correlation between global or regional myocardial 123I-MIBG uptake, however, and duration of diabetes, HbA1c, body mass index or QT interval length was not observed. Our study demonstrates that cardiac sympathetic dysinnervation is common in long-term IDDM even in patients without ECG-based cardiac autonomic neuropathy and that the posterior myocardium is predominantly affected. We conclude that 123I-MIBG scintigraphy is a promising approach to further elucidate the pattern and natural history of myocardial dysinnervation in IDDM.
Schnell
O
O
Diabetes Research Institute, Munich, Germany.
Kirsch
C M
CM
Stemplinger
J
J
Haslbeck
M
M
Standl
E
E
D019797:3-Iodobenzylguanidine; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D011877:Radionuclide Imaging; D013564:Sympathetic Nervous System / Q000503:physiopathology
D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019797:3-Iodobenzylguanidine