title: Combined assessment of baroreflex sensitivity with iodine 123 metaiodobenzylguanidine scintigraphic findings strengthens the power of predictive value for cerebral and cardiovascular events in type 2 diabetic patients.
abstract: BACKGROUND
  We previously reported that baroreflex sensitivity (BRS) or cardiac iodine 123 metaiodobenzylguanidine ((123)I-MIBG) scintigraphic findings can predict cardiovascular prognosis in type 2 diabetic patients. We therefore tested the hypothesis that the combination of BRS and (123)I-MIBG scintigraphic findings could strengthen the predictive power for major adverse cerebral and cardiovascular events (MACCE).
  
  
  RESULTS
  From 1998, we have evaluated both BRS and (123)I-MIBG scintigraphy in 165 type 2 diabetic patients (77 females, 88 males, mean age 59 ± 12 years). Based on the ROC curves, depressed BRS was defined as <5.63 mmHg/s, and enhanced washout ratio (WR) was defined as ≥ 41.4%. Each patient was divided into 3 groups based on the "BRS-MIBG combination score" as follows: 0, patients having both preserved BRS and preserved WR; 1, patients having either depressed BRS or enhanced WR; 2, patients having both depressed BRS and enhanced WR. During the mean of 4.7 ± 2.7 years of follow-up, 19 patients developed MACCE. The MACCE-free ratio was significantly higher in the lower BRS-MIBG combination score group (log-rank 16.41, P=0.0003). Cox proportional hazards regression analysis revealed that BRS-MIBG combination score was independently associated with the incidence of MACCE (hazard ratio 4.06, P=0.0237).
  
  
  CONCLUSIONS
  Our results suggest that combined assessment of the BRS and (123)I-MIBG scintigraphic findings is more useful for identifying the type 2 diabetic patients at high risk for MACCE.
authors.affiliation: Cardiovascular Science, Faculty of Medicine, Oita University, Oita University, Yufu, Japan.
authors.forename: Yukichi
authors.initials: Y
authors.lastname: Murozono
authors.forename: Kunio
authors.initials: K
authors.lastname: Yufu
authors.forename: Naohiko
authors.initials: N
authors.lastname: Takahashi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Okada
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Shinohara
authors.forename: Mikiko
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Masahide
authors.initials: M
authors.lastname: Hara
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Saikawa
mesh_terms: D000368:Aged; D017704:Baroreflex; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012189:Retrospective Studies