Article

Investigation of parasympathetic and sympathetic cardiac innervation in diabetic neuropathy: heart rate variation versus meta-iodo-benzylguanidine measured by single photon emission computed tomography.

Department of Neurology, University Erlangen-Nuremberg, Germany.
Clinical Autonomic Research (impact factor: 1.3). 07/1994; 4(3):117-23. pp.117-23
Source: PubMed

ABSTRACT In diabetic neuropathy disturbed autonomic cardiac innervation is associated with shortened life expectancy. Sympathetic dysfunction is likely to play a role in cases of cardiac death. The quantitative uptake of the radiopharmaceutical iodine-123-meta-iodo-benzylguanidine (MIBG) can be measured by single photon emission computed tomography (SPECT). It is an index of the functional integrity of sympathetic neurones in the heart. The respiratory heart rate variation--as assessed by a computerized device--reflects mainly parasympathetic cardiac innervation. In 25 diabetic patients and 19 healthy subjects MIBG-SPECT and heart rate variation tests were carried out. MIBG scans in all normal subjects showed homogeneous uptake of activity. In 12 out of 25 patients at least two heart rate variation tests were abnormal. MIBG-SPECT was more sensitive (abnormal in 17 out of 25). The lack of correlation between MIBG-SPECT results and spectral analysis of heart rate variation suggest that spectral analysis alone should not be regarded as an indicator of sympathetic cardiac innervation.

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    Article: New imaging techniques for cardiovascular autonomic neuropathy: a window on the heart.
    M J Stevens
    [show abstract] [hide abstract]
    ABSTRACT: Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes, which results in disabling clinical manifestations and may predispose to sudden cardiac death. Recently, direct scintigraphic assessment of cardiac sympathetic integrity has become possible with the introduction of radiolabeled analogues of norepinephrine, which are actively taken up by the sympathetic nerve terminals of the heart. This article reviews how these techniques have been utilized to improve understanding of CAN complicating diabetes. Quantitative scintigraphic assessment of cardiac sympathetic innervation heart is possible with either [123I]-metaiodobenzylguanidine (MIBG) and single photon emission computed tomography (SPECT) or [11C]-hydroxyephedrine (HED) and positron emission tomography (PET). Studies in diabetic patients have explored the sensitivity of these techniques to detect CAN, characterize the effects of glycemic control on the progression of CAN and evaluate the effects of CAN on myocardial electrophysiology, blood flow regulation and function. Deficits of left ventricular (LV) [123I]-MIBG and [11C]-HED retention have been identified in diabetic subjects without abnormalities on cardiovascular reflex testing consistent with increased sensitivity to detect CAN. Poor glycemic control results in the progression of LV tracer deficits, which can be prevented or reversed by the institution of near-euglycemia. Deficits begin distally in the LV and may extend proximally. Paradoxically, however, absolute HED retention is increased in the proximal segments of the severe CAN subjects consistent with regional "hyperinnervation." These regions also exhibit abnormal blood flow regulation. Impaired myocardial MIBG uptake correlates with altered LV diastolic filling and myocardial electrophysiological deficits and is predictive of sudden death. Scintigraphic studies have provided unique insights into the effects of diabetes on cardiac sympathetic integrity and the pathophysiological consequences of LV sympathetic dysinnervation. Future studies using complementary neurotransmitter analogues will allow different aspects of regional dysfunction to be characterized with the aim of developing therapeutic strategies to prevent or reverse CAN.
    Diabetes Technology &amp Therapeutics 02/2001; 3(1):9-22. · 1.93 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

19 healthy subjects MIBG-SPECT
 
25 diabetic patients
 
autonomic cardiac innervation
 
cases
 
diabetic neuropathy
 
functional integrity
 
heart rate variation
 
heart rate variation tests
 
homogeneous uptake
 
MIBG-SPECT
 
MIBG-SPECT results
 
quantitative uptake
 
radiopharmaceutical iodine-123-meta-iodo-benzylguanidine
 
sensitive
 
single photon emission computed tomography
 
SPECT
 
spectral analysis
 
sympathetic cardiac innervation
 
Sympathetic dysfunction
 
sympathetic neurones
 

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