Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 9/2010

Open Access 01-08-2010 | Original Article

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

Authors: Arthur J. H. A. Scholte, Joanne D. Schuijf, Victoria Delgado, Jurriaan A. Kok, Mieke T. J. Bus, Arie C. Maan, Marcel P. Stokkel, Antje V. Kharagitsingh, Petra Dibbets-Schneider, Ernst E. van der Wall, Jeroen J. Bax

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 9/2010

Login to get access

Abstract

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 123I-metaiodobenzylguanidine (123I-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 123I-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 123I-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 123I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, 123I-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 123I-mIBG scintigraphy for the assessment of CAN was observed.
Literature
1.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–53.CrossRefPubMed
2.
Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229–34.CrossRefPubMed
3.
Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, et al. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 2004;27:1954–61.CrossRefPubMed
4.
Gerritsen J, Dekker JM, TenVoorde BJ, Kostense PJ, Heine RJ, Bouter LM, et al. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care 2001;24:1793–8.CrossRefPubMed
5.
Schonauer M, Thomas A, Morbach S, Niebauer J, Schonauer U, Thiele H. Cardiac autonomic diabetic neuropathy. Diab Vasc Dis Res 2008;5:336–44.CrossRefPubMed
6.
Nagamachi S, Fujita S, Nishii R, Futami S, Tamura S, Mizuta M, et al. Prognostic value of cardiac I-123 metaiodobenzylguanidine imaging in patients with non-insulin-dependent diabetes mellitus. J Nucl Cardiol 2006;13:34–42.CrossRefPubMed
7.
Yufu K, Takahashi N, Nakagawa M, Hara M, Saikawa T, Yoshimatsu H. Brain natriuretic peptide and cardiac autonomic function in type 2 diabetic patients. Diabetes Res Clin Pract 2006;72:12–9.CrossRefPubMed
8.
Uehara A, Kurata C, Sugi T, Mikami T, Shouda S. Diabetic cardiac autonomic dysfunction: parasympathetic versus sympathetic. Ann Nucl Med 1999;13:95–100.CrossRefPubMed
9.
Takahashi N, Nakagawa M, Saikawa T, Ooie T, Yufu K, Shigematsu S, et al. Effect of essential hypertension on cardiac autonomic function in type 2 diabetic patients. J Am Coll Cardiol 2001;38:232–7.CrossRefPubMed
10.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008;31 Suppl 1:S55–60.CrossRef
11.
Rose G, McCartney P, Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med 1977;31:42–8.PubMed
12.
Scholte AJ, Schuijf JD, Kharagjitsingh AV, bbets-Schneider P, Stokkel MP, Jukema JW, et al. Different manifestations of coronary artery disease by stress SPECT myocardial perfusion imaging, coronary calcium scoring, and multislice CT coronary angiography in asymptomatic patients with type 2 diabetes mellitus. J Nucl Cardiol 2008;15:503–9.CrossRefPubMed
13.
14.
Schinkel AF, Bax JJ, Sozzi FB, Boersma E, Valkema R, Elhendy A, et al. Prevalence of myocardial viability assessed by single photon emission computed tomography in patients with chronic ischaemic left ventricular dysfunction. Heart 2002;88:125–30.CrossRefPubMed
15.
Ewing DJ, Campbell IW, Clarke BF. Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med 1980;92:308–11.PubMed
16.
Schnell O, Hammer K, Muhr-Becker D, Ziegler A, Weiss M, Tatsch K, et al. Cardiac sympathetic dysinnervation in type 2 diabetes mellitus with and without ECG-based cardiac autonomic neuropathy. J Diabetes Complications 2002;16:220–7.CrossRefPubMed
17.
Athyros VG, Didangelos TP, Karamitsos DT, Papageorgiou AA, Boudoulas H, Kontopoulos AG. Long-term effect of converting enzyme inhibition on circadian sympathetic and parasympathetic modulation in patients with diabetic autonomic neuropathy. Acta Cardiol 1998;53:201–9.PubMed
18.
Morguet A, Springer HJ. Microcomputer-based measurement of beat-to-beat intervals and analysis of heart rate variability. Med Prog Technol 1981;8:77–82.PubMed
19.
Sundkvist G, Almer L, Lilja B. Respiratory influence on heart rate in diabetes mellitus. Br Med J 1979;1:924–5.CrossRefPubMed
20.
Levin AB. A simple test of cardiac function based upon the heart rate changes induced by the Valsalva maneuver. Am J Cardiol 1966;18:90–9.CrossRefPubMed
21.
Ziegler D, Laux G, Dannehl K, Spuler M, Muhlen H, Mayer P, et al. Assessment of cardiovascular autonomic function: age-related normal ranges and reproducibility of spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses. Diabet Med 1992;9:166–75.CrossRefPubMed
22.
23.
Rose GA, Blackburn H. Cardiovascular survey methods. Monogr Ser World Health Organ 1968;56:1–188.PubMed
24.
Turpeinen AK, Vanninen E, Kuikka JT, Uusitupa MI. Demonstration of regional sympathetic denervation of the heart in diabetes. Comparison between patients with NIDDM and IDDM. Diabetes Care 1996;19:1083–90.CrossRefPubMed
25.
Estorch M, Carrio I, Berna L, Lopez-Pousa J, Torres G. Myocardial iodine-labeled metaiodobenzylguanidine 123 uptake relates to age. J Nucl Cardiol 1995;2:126–32.PubMed
26.
Kasama S, Toyama T, Sumino H, Nakazawa M, Matsumoto N, Sato Y, et al. Prognostic value of serial cardiac 123I-MIBG imaging in patients with stabilized chronic heart failure and reduced left ventricular ejection fraction. J Nucl Med 2008;49:907–14.CrossRefPubMed
27.
Ohshima S, Isobe S, Izawa H, Nanasato M, Ando A, Yamada A, et al. Cardiac sympathetic dysfunction correlates with abnormal myocardial contractile reserve in dilated cardiomyopathy patients. J Am Coll Cardiol 2005;46:2061–8.CrossRefPubMed
28.
Somsen GA, Verberne HJ, Fleury E, Righetti A. Normal values and within-subject variability of cardiac I-123 MIBG scintigraphy in healthy individuals: implications for clinical studies. J Nucl Cardiol 2004;11:126–33.CrossRefPubMed
29.
Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care 2003;26:1553–79.CrossRefPubMed
30.
Zipes DP, Wellens HJ. Sudden cardiac death. Circulation 1998;98:2334–51.PubMed
31.
Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab 2005;90:5896–903.CrossRefPubMed
32.
Sztajzel J. Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system. Swiss Med Wkly 2004;134:514–22.PubMed
33.
Kataoka M, Ito C, Sasaki H, Yamane K, Kohno N. Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes. Diabetes Res Clin Pract 2004;64:51–8.CrossRefPubMed
34.
35.
Ewing DJ, Campbell IW, Clarke BF. Mortality in diabetic autonomic neuropathy. Lancet 1976;1:601–3.CrossRefPubMed
36.
37.
Ziegler D, Weise F, Langen KJ, Piolot R, Boy C, Hubinger A, et al. Effect of glycaemic control on myocardial sympathetic innervation assessed by [123I]metaiodobenzylguanidine scintigraphy: a 4-year prospective study in IDDM patients. Diabetologia 1998;41:443–51.CrossRefPubMed
38.
Valensi P, Sachs RN, Harfouche B, Lormeau B, Paries J, Cosson E, et al. Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischemia. Diabetes Care 2001;24:339–43.CrossRefPubMed
39.
Langer A, Freeman MR, Josse RG, Armstrong PW. Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia. J Am Coll Cardiol 1995;25:610–8.CrossRefPubMed
40.
Schnell O, Kirsch CM, Stemplinger J, Haslbeck M, Standl E. Scintigraphic evidence for cardiac sympathetic dysinnervation in long-term IDDM patients with and without ECG-based autonomic neuropathy. Diabetologia 1995;38:1345–52.CrossRefPubMed
41.
Schnell O, Muhr D, Weiss M, Dresel S, Haslbeck M, Standl E. Reduced myocardial 123I-metaiodobenzylguanidine uptake in newly diagnosed IDDM patients. Diabetes 1996;45:801–5.CrossRefPubMed
42.
Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982;285:916–8.CrossRef
43.
Scott LA, Kench PL. Cardiac autonomic neuropathy in the diabetic patient: does 123I-MIBG imaging have a role to play in early diagnosis? J Nucl Med Technol 2004;32:66–71.PubMed
44.
Schnell O, Muhr D, Dresel S, Weiss M, Haslbeck M, Standl E. Partial restoration of scintigraphically assessed cardiac sympathetic denervation in newly diagnosed patients with insulin-dependent (type 1) diabetes mellitus at one-year follow-up. Diabet Med 1997;14:57–62.CrossRefPubMed
45.
Hattori N, Tamaki N, Hayashi T, Masuda I, Kudoh T, Tateno M, et al. Regional abnormality of iodine-123-MIBG in diabetic hearts. J Nucl Med 1996;37:1985–90.PubMed
46.
Anan F, Takahashi N, Nakagawa M, Ooie T, Saikawa T, Yoshimatsu H. High-sensitivity C-reactive protein is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Metabolism 2005;54:552–8.CrossRefPubMed
47.
Anan F, Takahashi N, Shinohara T, Nakagawa M, Masaki T, Katsuragi I, et al. Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Eur J Clin Invest 2006;36:459–65.CrossRefPubMed
48.
Anan F, Masaki T, Yonemochi H, Takahashi N, Nakagawa M, Eshima N, et al. Abdominal visceral fat accumulation is associated with the results of (123)I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients. Eur J Nucl Med Mol Imaging 2007;34:1189–97.CrossRefPubMed
49.
Anan F, Yonemochi H, Masaki T, Takahashi N, Nakagawa M, Eshima N, et al. Homocysteine levels are associated with the results of 123I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients. Eur J Nucl Med Mol Imaging 2007;34:28–35.CrossRefPubMed
50.
Howorka K, Pumprla J, Haber P, Koller-Strametz J, Mondrzyk J, Schabmann A. Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. Cardiovasc Res 1997;34:206–14.CrossRefPubMed
51.
Kontopoulos AG, Athyros VG, Didangelos TP, Papageorgiou AA, Avramidis MJ, Mayroudi MC, et al. Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic neuropathy. Diabetes Care 1997;20:355–61.CrossRefPubMed
52.
Ziegler D. Diabetic cardiovascular autonomic neuropathy: prognosis, diagnosis and treatment. Diabetes Metab Rev 1994;10:339–83.CrossRefPubMed
Metadata
Title
Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of 123I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability
Authors
Arthur J. H. A. Scholte
Joanne D. Schuijf
Victoria Delgado
Jurriaan A. Kok
Mieke T. J. Bus
Arie C. Maan
Marcel P. Stokkel
Antje V. Kharagitsingh
Petra Dibbets-Schneider
Ernst E. van der Wall
Jeroen J. Bax
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 9/2010
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-010-1442-0

Other articles of this Issue 9/2010

European Journal of Nuclear Medicine and Molecular Imaging 9/2010 Go to the issue

Society communications

21st Meeting of the Hellenic Society of Nuclear Medicine

Original Article

Simultaneous dual-radionuclide myocardial perfusion imaging with a solid-state dedicated cardiac camera

Original Article

Dose-response relationship in cyclophosphamide-treated B-cell lymphoma xenografts monitored with [18F]FDG PET

Original Article

ECG-triggered 18F-fluorodeoxyglucose positron emission tomography imaging of the rat heart is dramatically enhanced by acipimox

Original Article

18F-FDG PET/CT in the characterization and surgical decision concerning adrenal masses: a prospective multicentre evaluation

Erratum

Erratum to: Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia