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

Scholte, A.J.H.A.; Schuijf, J.D.; Delgado, V.; Kok, J.A.; Bus, M.T.J.; Maan, A.C.; ... ; Bax, J.J. (2010)

Article / Letter to editor

PURPOSE 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. CONCLUSION 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.

• All authors: 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.
• Date: 2010-08-31
• Journal: European Journal of Nuclear Medicine and Molecular Imaging
• Volume: 37
• Issue: 9
• Pages: 1698 - 705
• DOI: doi:10.1007/s00259-010-1442-0