Noninvasive assessment of cardiac diabetic neuropathy by carbon-11 hydroxyephedrine and positron emission tomography

Allman, Kevin C.; Stevens, Martin J.; Wieland, Donald M.; Hutchins, Gary D.; Wolfe, Edwin R.; Greene, Douglas A.; Schwaiger, Markus

doi:10.1016/0735-1097(93)90553-d

Cited by 113 publications

(68 citation statements)

References 11 publications

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“…Assessment of the heart by PET with 11C-HED in Type I diabetes confirms the frequent sympathetic dysinnervation and the predominance in the posterior myocardial region [79]. Complicating the heterogeneous cardiac sympathetic dysinnervation, with PET diabetic patients have been shown to have proximal sympathetic hyperinnervation of the heart [52].…”

Section: Scintigraphically Assessed Cardiac Sympathetic Dysfunctionmentioning

confidence: 99%

See 1 more Smart Citation

A new look at the heart in diabetes mellitus: from ailing to failing

Standl

Schnell

2000

Diabetologia

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Section: Scintigraphically Assessed Cardiac Sympathetic Dysfunctionmentioning

confidence: 99%

“…Unlike noradreanline, MIBG and HED are metabolized neither by monoaminooxidase nor by catecholamine-O-methyltransferase [64,75,77]. They are rapidly excreted in the urine in their unmetabolized form [75,79,82].…”

Section: Scintigraphically Assessed Cardiac Sympathetic Dysfunctionmentioning

confidence: 99%

A new look at the heart in diabetes mellitus: from ailing to failing

Standl

Schnell

2000

Diabetologia

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“…The distribution of myocardial sympathetic nerves can be assessed by dual-isotope imaging with radiolabelled metaiodobenzylguanidine, a norepinephrine analogue, or with radiolabelled catecholamines visualized by positron emission tomography [74,75]. Theoretically, these techniques should add valuable information to the heart-rate based testing of autonomic function, although they cannot distinguish between afferent and efferent nerve endings.…”

Section: Sympathetic Innervation Of the Heart And Lack Of Cardiac Painmentioning

confidence: 99%

Silent coronary artery disease in diabetes - a feature of autonomic neuropathy or accelerated atherosclerosis?

Airaksinen

2001

Diabetologia

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It is generally accepted that diabetic patients with acute myocardial infarction often present with atypical symptoms and the infarction can be completely painless. Autonomic damage is regarded as the cause for the blunted appreciation of pain during acute coronary events, but both of these contentions are open to discussion. The purpose of this paper is to evaluate critically the information available on these relations. Silent myocardial infarction in patients with diabetesThe concept that silent myocardial infarction is a characteristic of coronary artery disease in the presence of diabetes was originally based on the early report of Bradley and Schonfeld [l]. They found that diabetic patients who were admitted to hospital for myocardial infarction more often had little or no pain during infarction than non-diabetic patients. There is also a necropsy study of 61 patients suggesting that unrecognized myocardial infarction is more common in diabetic subjects [2]. These studies based on hospital and necropsy records cannot definitely prove, however, that painless myocardial infarction is more common in the whole diabetic population because the results could be modified by selection bias. It is reasonable to assume that diabetic patients have a closer medical follow-up and are admitted more readily to hospital for symptoms related to their diabetic status [3], e. g. uncontrolled diabetes, nausea or general weakness. These circumstances could erroneously increase the proportion of painless and atypical infarctions in hospital patients who are diabetic compared with these who are non-diabetic but later reports based on hospital records have failed to show any difference in the frequency of painless acute myocardial infarction between diabetic and non-diabetic patients [3±5].Population-based epidemiological studies are likely to provide more reliable information on the incidence of unrecognized myocardial infarctions in dia- AbstractAsymptomatic coronary artery disease and myocardial infarctions are common in diabetic subjects. The available clinical and epidemiological data suggest that the increased incidence of asymptomatic myocardial infarctions and coronary artery disease in diabetic patients mainly reflects accelerated coronary atherosclerosis and the proportion of silent disease relative to symptomatic disease or episodes is not increased in diabetes. In spite of the theoretical background, there is no convincing clinical or epidemiological evidence that diabetic autonomic neuropathy plays a major part in the lack of ischaemic pain. This is not surprising because the mechanisms of silent myocardial ischaemia are complex and controversial even without diabetes. [Diabetologia (2001) 44: 259± 266]

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“…Although the use of these tests has given rise to criticism and many noninvasive tests have appeared to assess the autonomic nervous function, they are expensive, they were not used in large populations and their sensitivities have not been established. If today we decide to perform an epidemiological study which includes the determination of the cardiovascular autonomic function in diabetic subjects at least one of the tests proposed by Ewing and Clarke must be done, complemented or not with alternative mathematical approaches for measuring heart rate variation (5,6), images with metaiodobenzylguanidine (7) or images obtained with positron emission tomography (8).…”

Section: Introductionmentioning

confidence: 99%

Standardization of a computerized method for calculating autonomic function test responses in healthy subjects and patients with diabetes mellitus

Neumann

Schmid²

1997

Braz J Med Biol Res

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The objectives of the present study were 1) to compare results obtained by the traditional manual method of measuring heart rate (HR) and heart rate response (HRR) to the Valsalva maneuver, standing and deep breathing, with those obtained using a computerized data analysis system attached to a standard electrocardiograph machine; 2) to standardize the responses of healthy subjects to cardiovascular tests, and 3) to evaluate the response to these tests in a group of patients with diabetes mellitus (DM). In all subjects (97 healthy and 143 with DM) we evaluated HRR to deep breathing, HRR to standing, HRR to the Valsalva maneuver, and blood pressure response (BPR) to standing up and to a sustained handgrip. Since there was a strong positive correlation between the results obtained with the computerized method and the traditional method, we conclude that the new method can replace the traditional manual method for evaluating cardiovascular responses with the advantages of speed and objectivity. HRR and BPR of men and women did not differ. A correlation between age and HRR was observed for standing (r = -0.48, P<0.001) and deep breathing (r = -0.41; P<0.002). Abnormal BPR to standing was usually observed only in diabetic patients with definite and severe degrees of autonomic neuropathy.

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Noninvasive assessment of cardiac diabetic neuropathy by carbon-11 hydroxyephedrine and positron emission tomography

Cited by 113 publications

References 11 publications

A new look at the heart in diabetes mellitus: from ailing to failing

A new look at the heart in diabetes mellitus: from ailing to failing

Silent coronary artery disease in diabetes - a feature of autonomic neuropathy or accelerated atherosclerosis?

Standardization of a computerized method for calculating autonomic function test responses in healthy subjects and patients with diabetes mellitus

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