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Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia.

Publication ,  Journal Article
Langer, A; Freeman, MR; Josse, RG; Armstrong, PW
Published in: J Am Coll Cardiol
March 1, 1995

OBJECTIVES: This study in patients with diabetes mellitus was undertaken 1) to evaluate cardiac sympathetic innervation in diabetic patients using metaiodobenzylguanidine (MIBG) imaging; 2) to study the relation between autonomic function assessed by clinical maneuvers and abnormalities in MIBG uptake; and 3) to examine the basis for our previous observation of an association between abnormalities in autonomic nervous system dysfunction and silent myocardial ischemia. BACKGROUND: The clinical detection of autonomic dysfunction in diabetes mellitus has been linked to both abnormal perception of pain, including angina, and poor prognosis. METHODS: Uptake of MIBG was measured by dual-isotope imaging in 23 normal subjects and 65 asymptomatic diabetic patients. Silent myocardial ischemia was defined as the presence of a reversible perfusion defect in patients with ST segment depression. RESULTS: The MIBG uptake in the diabetic patients was significantly lower than that in normal subjects in the apex (67 +/- 17% vs. 82 +/- 7%, p = 0.0001), distal third (77 +/- 11% vs. 85 +/- 3%, p = 0.0001), proximal third (77 +/- 9% vs. 84 +/- 3%, p = 0.0001) and base (71 +/- 9% vs. 80 +/- 4%, p = 0.0001) of the left ventricle. Similarly, MIBG uptake was variable across different vascular territories. When MIBG uptake was corrected for perfusion abnormalities, diabetic patients had a greater MIBG uptake defect than normal subjects on visual score assessment (16 +/- 13 vs. 8 +/- 7%, p = 0.0002) and on quantitative MIBG mismatch assessment (13 +/- 15% vs. 2 +/- 2%, p = 0.0001). Diabetic patients with versus without autonomic dysfunction had more extensive MIBG uptake mismatch (17 +/- 17% vs. 4 +/- 6%, p = 0.0001). There was a greater diffuse abnormality in diabetic patients with versus without silent myocardial ischemia detected by sestamibi/MIBG uptake ratio (68 +/- 35% vs. 19 +/- 33%, p = 0.001). CONCLUSIONS: Sympathetic cardiac innervation in normal subjects is inhomogeneous. In contrast to normal subjects, diabetic patients have evidence of a significant reduction in MIBG uptake, most likely on the basis of autonomic dysfunction. Furthermore, diabetic patients with silent myocardial ischemia have evidence of a diffuse abnormality in MIBG uptake, suggesting that abnormalities in pain perception may be linked to sympathetic denervation.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 1, 1995

Volume

25

Issue

3

Start / End Page

610 / 618

Location

United States

Related Subject Headings

  • Sympatholytics
  • Sympathetic Nervous System
  • Radionuclide Imaging
  • Myocardial Ischemia
  • Male
  • Iodobenzenes
  • Iodine Radioisotopes
  • Humans
  • Heart
  • Female
 

Citation

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Langer, A., Freeman, M. R., Josse, R. G., & Armstrong, P. W. (1995). Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia. J Am Coll Cardiol, 25(3), 610–618. https://doi.org/10.1016/0735-1097(94)00459-4
Langer, A., M. R. Freeman, R. G. Josse, and P. W. Armstrong. “Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia.J Am Coll Cardiol 25, no. 3 (March 1, 1995): 610–18. https://doi.org/10.1016/0735-1097(94)00459-4.
Langer, A., et al. “Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia.J Am Coll Cardiol, vol. 25, no. 3, Mar. 1995, pp. 610–18. Pubmed, doi:10.1016/0735-1097(94)00459-4.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 1, 1995

Volume

25

Issue

3

Start / End Page

610 / 618

Location

United States

Related Subject Headings

  • Sympatholytics
  • Sympathetic Nervous System
  • Radionuclide Imaging
  • Myocardial Ischemia
  • Male
  • Iodobenzenes
  • Iodine Radioisotopes
  • Humans
  • Heart
  • Female