Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of I-123-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability

Author(s):
Scholte, A.J.H.A.; Schuijf, J.D.; Delgado, V.; Kok, J.A.; Bus, M.T.J.; Maan, A.C.; Stokkel, M.P.; Kharagitsingh, A.V.; Dibbets-Schneider, P.; Wall, E.E. van der; Bax, J.J.
Published
2010
Publication type
Article / Letter to editor

Abstract

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 I-123-metaiodobenzylguanidine (I-123-mIBG) myocardial scintigraphy. 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 I-123-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 I-123-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. The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and I-123-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, I-123-mIBG scintigraphy showed CAN. The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and I-123-mIBG scintigraphy for the assessment of CAN was observed.

Diabetes Cardiac autonomic neuropathy Heart rate variability I-123-mIBG scintigraphy sympathetic denervation iddm patients insulin-resistance prognostic value mellitus dysfunction mortality ischemia manifestations dysinnervation
Date issued
2010-08-31
Language
English
Is part of
European Journal of Nuclear Medicine and Molecular Imaging (2010), Vol. 37, no. 9, p. 1698-1705
hdl
1887/109083
doi
10.1007/s00259-010-1442-0