Scintigraphic Assessment of Regionalized Defects in Myocardial Sympathetic Innervation and Blood Flow Regulation in Diabetic Patients With Autonomic Neuropathy

Stevens, Martin J.; Dayanikli, Firat; Raffel, David M.; Allman, Kevin C.; Sandford, Tracy; Feldman, Eva L.; Wieland, Donald M.; Corbett, James R.; Schwaiger, M

doi:10.1016/s0735-1097(98)00128-4

Cited by 118 publications

(79 citation statements)

References 47 publications

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“…However, most of the previous studies have included patients with both Type 1 and Type 2 diabetes or other potentially confounding factors such as diabetic complications, smoking, hypertension, obesity and lipid abnormalities, which are known to further reduce coronary vasoreactivity. Consistent with the results of the present study, the findings of one previous PET study demonstrated that patients with Type 1 diabetes and autonomic neuropathy have decreased adenosinestimulated coronary vasoreactivity, while the non-neuropathic Type 1 diabetic patients have unaltered myocardial blood flow and coronary flow reserve [28]. Thus, the question of whether coronary reactivity is impaired in non-complicated Type 1 diabetes is still being debated.…”

Section: Discussionsupporting

confidence: 92%

“…In previous studies, coronary vasoreactivity has been found to be either normal [28] or more frequently decreased [8,29,30,31,32] in diabetic patients. However, most of the previous studies have included patients with both Type 1 and Type 2 diabetes or other potentially confounding factors such as diabetic complications, smoking, hypertension, obesity and lipid abnormalities, which are known to further reduce coronary vasoreactivity.…”

Section: Discussionmentioning

confidence: 90%

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Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

et al. 2004

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Aims/hypothesis. We examined whether diabetic background retinopathy is associated with reduced coronary vasoreactivity in people with Type 1 diabetes. Methods. A total of 21 men with Type 1 diabetes were investigated, including 9 men with background retinopathy and 12 men without retinopathy. In addition, 12 non-diabetic, age-matched subjects were studied. All subjects were non-smokers, otherwise healthy and had no other diabetic complications. Resting myocardial blood flow and hyperaemic dipyridamole-stimulated flow (dipyridamole, 0.56 mg/kg during a 4-min period), a measure of coronary vasoreactivity, were measured during euglycaemic hyperinsulinaemic clamp (1 mU·kg −1 ·min −1 ) using positron emission tomography and oxygen-15-labelled water. Results. Resting myocardial blood flow (0.82±0.13 vs 0.96±0.23 vs 0.88±0.25 ml·g −1 ·min −1 , with vs without retinopathy vs non-diabetic subjects) and coronary vascular resistance (111.2±23.4 vs 95.5±15.8 vs 101.9±31.5 mmHg·min·g·ml −1 respectively) were not significantly different between the groups. Dipyridamole infusion induced an increase in blood flow and a decrease in coronary vascular resistance in all study subjects (p<0.001). However, dipyridamole-stimulated flow and coronary vascular resistance were blunted in diabetic patients with retinopathy (2.9±0.9 ml·g −1 · min −1 and 34.1±11.3 mmHg·min·g·ml −1 ) when compared to diabetic patients without retinopathy (4.0±1.3 ml·g −1 ·min −1 , p=0.04 and 24.6±7.5 mmHg·min·g·ml −1 , p=0.03) or non-diabetic subjects (4.5±1.4 ml·g −1 ·min −1 , p=0.008 and 22.2±8.7 mmHg·min·g·ml −1 , p=0.01). Myocardial flow reserve was impaired in diabetic patients with retinopathy (3.6±1.0) when compared to non-diabetic subjects (5.3±1.9, p=0.02) but not significantly reduced when compared to diabetic patients without retinopathy (4.2±1.4, p=0.2). Conclusions/interpretation. Diabetic background retinopathy appears to be associated with impaired coronary vasoreactivity in young people with Type 1 diabetes.Keywords Myocardial blood flow · Type 1 diabetes · Retinopathy · Dipyridamole · Positron emission tomography

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 90%

Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

et al. 2004

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“…The increased flow at baseline and the diminished increase in relative blood flow and venous oxygen saturation over the course of haemodialysis in the diabetic group suggest the presence of neuropathy. A similar observation has been made in the myocardium, in which neurogenic reflexes play an important role in controlling tissue microcirculation [16,17]. Nevertheless, we cannot rule out the possibility that the differences we observed could have resulted from different degrees of arterial calcification in the two groups.…”

Section: Discussionsupporting

confidence: 74%

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

et al. 2009

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Aims To examine the cutaneous microcirculation on the dorsum of the foot before, during and after haemodialysis in diabetic and non-diabetic patients. MethodsFourteen age-matched patients (seven diabetic, seven non-diabetic) without active foot ulceration were studied. Cutaneous microcirculation was assessed using a micro-lightguide spectrophotometer to measure venous oxygen saturation and relative blood flow determined at two tissue depths: 2 and 6 mm. Cumulative relative changes of each parameter during haemodialysis were calculated as area under the curve. Differences between and within the groups were calculated by Mann-Whitney U -test and ANOVA following post hoc testing, respectively.Results At baseline, relative blood flow at 6 mm tissue depth was significantly greater in diabetic patients ( P = 0.048). Thirty minutes after the end of dialysis, relative blood flow at 2 and 6 mm tissue depth was significantly higher in nondiabetic patients ( P = 0.048 and P = 0.001). Mean cumulative relative changes in venous oxygen saturation and relative blood flow at 2 mm as well as 6 mm tissue depth were positive for non-diabetic subjects and negative for diabetic patients. ConclusionsHaemodialysis is associated with changes in cutaneous microcirculation, which differ between people with and without diabetes. In those without diabetes, we found an increase in blood flow during haemodialysis, whereas blood flow was reduced in diabetic patients. This may be the result of abnormal vasomotor regulation due to distal neuropathy. Diabet. Med. 26, 89-92 (2009)

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“…* p = 0.012, ** p < 0.001 [109] Type II diabetic patients [109, 113±115]. Recent studies suggest that cardiac sympathetic dysfunction affecting cardiac sympathetic efferent sympathetic signals is directly related to coronary blood flow in diabetes [109,113,116]. Sympathetically mediated myocardial blood flow, as induced by cold pressor test, was increased by 31 % in diabetic patients without scintigraphically assessed cardiac sympathetic dysinnervation compared with only 14 % in diabetic patients with cardiac sympathetic dysinnervation [113].…”

Section: Coronary Blood Flow Reservementioning

confidence: 99%

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

Standl

Schnell

2000

Diabetologia

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Scintigraphic Assessment of Regionalized Defects in Myocardial Sympathetic Innervation and Blood Flow Regulation in Diabetic Patients With Autonomic Neuropathy

Cited by 118 publications

References 47 publications

Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

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

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