Scintigraphic evidence for cardiac sympathetic dysinnervation in long-term IDDM patients with and without ECG-based autonomic neuropathy

Schnell, Oliver; Kirsch, C.-M.; Stemplinger, J.; Haslbeck, M.; Standl, Eberhard

doi:10.1007/s001250050433

Cited by 19 publications

(41 citation statements)

References 23 publications

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“…This is in agreement with recently published data on long-term IDDM patients suggesting that cardiac sympathetic dysinnervation is often present, even in the absence of ECG-based cardiac autonomic neuropathy (9,10). We now give evidence that cardiac sympathetic dysinnervation is not confined to long-term IDDM, but can already be observed at diagnosis of IDDM.…”

Section: Discussionsupporting

confidence: 93%

“…Our results give further evidence for a superior sensitivity of 123 I-MIBG scintigraphy in detecting early cardiac dysinnervation compared with indirect cardiac reflex tests (6,7,9,10). Because of the specific affinity of the tracer to postganglionary sympathetic nerve endings, 123 I-MIBG scintigraphy allows a direct assessment of the cardiac sympathetic nervous system (18,19).…”

Section: Discussionmentioning

confidence: 66%

“…Images were obtained after 5 h to allow for intraneuronal accumulation and extraneuronal clearance of 123 I-MIBG (25). The limitation of SPECT, however, which allows only a relative quantitative analysis of tracer uptake, has to be mentioned (10,26).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, single-photon emission computed tomography (SPECT) using the guanethidine analog 123 Mabeled metaiodobenzylguanidine ( 123 I-MIBG), initially performed for detection of pheochromocytoma, has been introduced for a direct and noninvasive evaluation of global and regional distributions of cardiac sympathetic dysinnervation in long-term diabetes (6)(7)(8)(9)(10). Scintigraphically, it has been observed that the myocardial uptake of 123 I-MIBG not only is severely reduced in diabetes with ECG-based cardiac autonomic neuropathy but also-however to a smaller extent-in the absence of ECG-based cardiac autonomic neuropathy (6,(8)(9)(10).…”

mentioning

confidence: 99%

“…Scintigraphically, it has been observed that the myocardial uptake of 123 I-MIBG not only is severely reduced in diabetes with ECG-based cardiac autonomic neuropathy but also-however to a smaller extent-in the absence of ECG-based cardiac autonomic neuropathy (6,(8)(9)(10). In addition, the reduction of 123 I-MIBG uptake is not homogeneous throughout the myocardium in diabetic patients but demonstrates significant regional variations ( 8 -10).…”

mentioning

confidence: 99%

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Reduced Myocardial 123I-Metaiodobenzylguanidine Uptake in Newly Diagnosed IDDM Patients

Schnell

Muhr

Weiss³

et al. 1996

Diabetes

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123I-labeled metaiodobenzylguanidine (123I-MIBG) scintigraphy is a novel technique for the assessment of cardiac sympathetic dysinnervation. To evaluate defects of the cardiac autonomic nervous system at the onset of IDDM, this technique together with conventional electrocardiogram (ECG)-based cardiac reflex tests and measurement of the QT interval was applied to 22 newly diagnosed metabolically stabilized IDDM patients without myocardial perfusion abnormalities (99mTc-labeled methoxyisobutylisonitrile scintigraphy) and 9 matched control subjects. Seventeen diabetic patients (77%), but none of the control subjects, were observed to have a reduced global myocardial uptake of 123I-MIBG. In contrast, only two diabetic patients (9%) demonstrated an ECG-based cardiac autonomic neuropathy (two or more of five age-related cardiac reflex tests abnormal) (P < 0.001). In newly diagnosed IDDM patients, the uptake of 123I-MIBG was reduced more in the posterior myocardial region compared with the lateral and apical region (P < 0.01, P = 0.03). The septal myocardial region exhibited a smaller uptake than the lateral myocardial region (P = 0.02). The maximum/minimum 30:15 ratio correlated with the global, anterior, lateral, and septal myocardial uptake of 123I-MIBG (P < 0.05, P < 0.05, P < 0.01, P < 0.05). A correlation between global and regional myocardial 123I-MIBG uptake and HbA1c or QT interval was not observed. Newly diagnosed metabolically stabilized IDDM patients without myocardial perfusion defects show evidence of cardiac sympathetic dysinnervation, as indicated by a reduction of 123I-MIBG uptake, at a significant higher proportion than ECG-based cardiac autonomic neuropathy. Furthermore, they present with regional differences of myocardial 123I-MIBG uptake.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Reduced Myocardial 123I-Metaiodobenzylguanidine Uptake in Newly Diagnosed IDDM Patients

Schnell

Muhr

Weiss³

et al. 1996

Diabetes

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Sympathetic mediated vasomotion and skin capillary permeability in diabetic patients with peripheral neuropathy

et al. 2003

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Aims/hypothesis. A loss of sympathetic function could lead to changes in capillary fluid filtration in diabetic patients. We investigated whether a decreased sympathetically mediated vasomotion in the skin in diabetic patients with peripheral neuropathy is associated with an abnormal capillary leakage. Methods. Three matched groups were studied: 18 diabetic patients with documented peripheral neuropathy (DN), 18 diabetic patients without peripheral neuropathy (D), and 18 healthy control subjects (C). Sensory and motor nerve function of the distal extremities were assessed by standard neurography, and expressed in a sensory-motor nerve function score. Sympathetic vasomotion of the skin microcirculation was assessed by determining the power of blood flow variability in the low-frequency (0.02-0.14 Hz) band by spectral analysis of laser Doppler flowmetry at the median ankle. Skin capillary leakage was evaluated by sodium fluorescein videodensitometry at the same site of the foot.Results. Sympathetically mediated vasomotion of the foot skin microcirculation was lower in diabetic patients with documented peripheral neuropathy compared with diabetic patients without peripheral neuropathy and control subjects (p<0.001). Capillary sodium fluorescein leakage was larger in 18 diabetic patients with documented peripheral neuropathy than in diabetic patients without peripheral neuropathy (p<0.02) and C (p<0.005). Multiple regression analysis disclosed that a reduced sympathetically mediated vasomotion, together with a lower sensory-motor nerve function score, independently contributed to the variance in sodium fluorescein leakage, for 30% (p<0.001) and 17% (p<0.01), respectively. Conclusions. A loss of sympathetic tone, apart from sensory-motor nerve dysfunction, seems to be a major determinant of an increased capillary permeability in diabetic patients with neuropathy. [Diabetologia (2003) 46:40-47]

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Influence of the polyol pathway on norepinephrine transporter reduction in diabetic cardiac sympathetic nerves: implications for heterogeneous accumulation of MIBG

Kiyono

Kajiyama

Fujiwara

et al. 2005

Eur J Nucl Med Mol Imaging

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Scintigraphic evidence for cardiac sympathetic dysinnervation in long-term IDDM patients with and without ECG-based autonomic neuropathy

Cited by 19 publications

References 23 publications

Reduced Myocardial 123I-Metaiodobenzylguanidine Uptake in Newly Diagnosed IDDM Patients

Reduced Myocardial 123I-Metaiodobenzylguanidine Uptake in Newly Diagnosed IDDM Patients

Sympathetic mediated vasomotion and skin capillary permeability in diabetic patients with peripheral neuropathy

Influence of the polyol pathway on norepinephrine transporter reduction in diabetic cardiac sympathetic nerves: implications for heterogeneous accumulation of MIBG

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