title: Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of 123I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and (123)I-metaiodobenzylguanidine ((123)I-mIBG) myocardial scintigraphy.
  
  
  METHODS
  The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and (123)I-mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by (123)I-mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was <1.8, the washout rate was >25%, or the total defect score was >13.
  
  
  RESULTS
  The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and (123)I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, (123)I-mIBG scintigraphy showed CAN.
  
  
  CONCLUSIONS
  The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and (123)I-mIBG scintigraphy for the assessment of CAN was observed.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. a.j.h.a.scholte@lumc.nl
authors.forename: Arthur J H A
authors.initials: AJ
authors.lastname: Scholte
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Jurriaan A
authors.initials: JA
authors.lastname: Kok
authors.forename: Mieke T J
authors.initials: MT
authors.lastname: Bus
authors.forename: Arie C
authors.initials: AC
authors.lastname: Maan
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Stokkel
authors.forename: Antje V
authors.initials: AV
authors.lastname: Kharagitsingh
authors.forename: Petra
authors.initials: P
authors.lastname: Dibbets-Schneider
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D019797:3-Iodobenzylguanidine; D001341:Autonomic Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000294:innervation / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019797:3-Iodobenzylguanidine
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