Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of 123I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability.
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.
Scholte
Arthur J H A
AJ
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. a.j.h.a.scholte@lumc.nl
Schuijf
Joanne D
JD
Delgado
Victoria
V
Kok
Jurriaan A
JA
Bus
Mieke T J
MT
Maan
Arie C
AC
Stokkel
Marcel P
MP
Kharagitsingh
Antje V
AV
Dibbets-Schneider
Petra
P
van der Wall
Ernst E
EE
Bax
Jeroen J
JJ
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
D019797:3-Iodobenzylguanidine
Diabetes Care. 2008 Jan;31 Suppl 1:S55-60
18165338
Eur J Clin Invest. 2006 Jul;36(7):459-65
16796602
Diabet Med. 1997 Jan;14(1):57-62
9017355
J Am Coll Cardiol. 1995 Mar 1;25(3):610-8
7860904
Br Med J (Clin Res Ed). 1982 Oct 2;285(6346):916-8
6811067
J Nucl Med. 2008 Jun;49(6):907-14
18483106
J Nucl Med. 1996 Dec;37(12):1985-90
8970519
Lancet. 1976 Mar 20;1(7960):601-3
55889
J Am Coll Cardiol. 2005 Dec 6;46(11):2061-8
16325043
Monogr Ser World Health Organ. 1968;56:1-188
4972212
Diabetes Care. 2004 Aug;27(8):1954-61
15277423
Circulation. 1998 Nov 24;98(21):2334-51
9826323
Diabetes Care. 2004 May;27(5):1047-53
15111519
J Nucl Cardiol. 2006 Jan-Feb;13(1):34-42
16464715
Diabetologia. 1995 Nov;38(11):1345-52
8582545
Eur J Nucl Med Mol Imaging. 2007 Jan;34(1):28-35
16896659
Ann Intern Med. 1980 Feb;92(2 Pt 2):308-11
7356219
J Nucl Cardiol. 1995 Mar-Apr;2(2 Pt 1):126-32
9420777
J Nucl Cardiol. 2002 Jan-Feb;9(1):75-94
11845133
J Am Coll Cardiol. 2001 Jul;38(1):232-7
11451280
Acta Cardiol. 1998;53(4):201-9
9842405
Diabetes Care. 2001 Feb;24(2):339-43
11213889
Metabolism. 2005 Apr;54(4):552-8
15798966
J Nucl Cardiol. 2004 Mar-Apr;11(2):126-33
15052243
Diabetes Res Clin Pract. 2004 Apr;64(1):51-8
15036827
Diabet Med. 1992 Mar;9(2):166-75
1563252
Diabetes Res Clin Pract. 2006 Apr;72(1):12-9
16298451
Diabetes Care. 1996 Oct;19(10):1083-90
8886553
Circulation. 2007 Jan 23;115(3):387-97
17242296
J Clin Endocrinol Metab. 2005 Oct;90(10):5896-903
16014401
Med Prog Technol. 1981;8(2):77-82
7266430
Diabetes Metab Rev. 1994 Dec;10(4):339-83
7796704
N Engl J Med. 1998 Jul 23;339(4):229-34
9673301
Br Med J. 1979 Apr 7;1(6168):924-5
435883
Diabetes. 1996 Jun;45(6):801-5
8635656
Diabetes Care. 2003 May;26(5):1553-79
12716821
Heart. 2002 Aug;88(2):125-30
12117829
Swiss Med Wkly. 2004 Sep 4;134(35-36):514-22
15517504
Diab Vasc Dis Res. 2008 Nov;5(4):336-44
18958844
Am J Cardiol. 1966 Jul;18(1):90-9
5938917
Br J Prev Soc Med. 1977 Mar;31(1):42-8
856370
Ann Nucl Med. 1999 Apr;13(2):95-100
10355953
Cardiovasc Res. 1997 Apr;34(1):206-14
9217892
Diabetologia. 1979 Oct;17(4):195-212
387501
Diabetes Care. 2001 Oct;24(10):1793-8
11574444
J Nucl Med Technol. 2004 Jun;32(2):66-71
15175402
Eur J Nucl Med Mol Imaging. 2007 Aug;34(8):1189-97
17415564
J Diabetes Complications. 2002 May-Jun;16(3):220-7
12015192
J Nucl Cardiol. 2008 Jul-Aug;15(4):503-9
18674717
Diabetologia. 1998 Apr;41(4):443-51
9562349
Diabetes Care. 1997 Mar;20(3):355-61
9051387