title: Impact of diabetes on cardiac sympathetic innervation in patients with heart failure: a 123I meta-iodobenzylguanidine (123I MIBG) scintigraphic study.
abstract: OBJECTIVE
  Impaired parasympathetic and sympathetic nervous system activity have been demonstrated in patients with diabetes mellitus (DM) and correlated with worse prognosis. Few data are available on the effect of DM on cardiac neuropathy in heart failure (HF). The aim of the current study was to assess cardiac sympathetic activity in HF patients with and without DM.
  
  
  METHODS
  Patients with severe HF (n = 75), with (n = 37) and without DM (n = 38), and 14 diabetic patients with normal cardiac function underwent (123)I meta-iodobenzylguanidine scintigraphy from which early and late heart-to-mediastinum (H/M) ratios were calculated. Clinical, echocardiographic, and biochemical data were measured.
  
  
  RESULTS
  DM compared with non-DM patients showed significantly lower early (1.65 ± 0.21 vs. 1.75 ± 0.21; P < 0.05) and late H/M ratios (1.46 ± 0.22 vs. 1.58 ± 0.24; P < 0.03). Early and late H/M were significantly higher in DM patients without HF (2.22 ± 0.35 and 1.99 ± 0.24, respectively) than HF patients with (P < 0.0001) and without (P < 0.0001) DM. In HF patients, an inverse correlation between early or late H/M ratio and hemoglobin A1c (HbA1c) (Pearson = -0.473, P = 0.001; Pearson = -0.382, P = 0.001, respectively) was observed. In DM, in multivariate analysis, HbA1c and ejection fraction remained significant predictors of early H/M; HbA1c remained the only significant predictor of late H/M. No correlation between early or late H/M and HbA1c was found in non-DM patients.
  
  
  CONCLUSIONS
  Diabetic patients with HF show lower cardiac sympathetic activity than HF patients not having DM or than DM patients with a similar degree of autonomic dysfunction not having HF. HbA1c correlated with the degree of reduction in cardiac sympathetic activity.
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples,Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolillo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rengo
authors.forename: Gennaro
authors.initials: G
authors.lastname: Pagano
authors.forename: Teresa
authors.initials: T
authors.lastname: Pellegrino
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.forename: Grazia D
authors.initials: GD
authors.lastname: Femminella
authors.forename: Marianna
authors.initials: M
authors.lastname: Tuccillo
authors.forename: Antonio
authors.initials: A
authors.lastname: Boemio
authors.forename: Emilio
authors.initials: E
authors.lastname: Attena
authors.forename: Roberto
authors.initials: R
authors.lastname: Formisano
authors.forename: Laura
authors.initials: L
authors.lastname: Petraglia
authors.forename: Francesco
authors.initials: F
authors.lastname: Scopacasa
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galasso
authors.forename: Dario
authors.initials: D
authors.lastname: Leosco
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006321:Heart / Q000000981:diagnostic imaging / Q000294:innervation*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013564:Sympathetic Nervous System / Q000503:physiopathology*
chemical_list: D019797:3-Iodobenzylguanidine; D006442:Glycated Hemoglobin; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; C517652:hemoglobin A1c protein, human