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

Objectives. The purpose of this investigation was to evaluate the sympathetic nervous system of the heart by positron emission tomographic (PET) imaging in patients with diabetes mellitus with and without diabetic autonomic neuropathy. Background. The clinical assessment of cardiac involvement in di...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1993-11, Vol.22 (5), p.1425-1432
Main Authors: Allman, Kevin C., Stevens, Martin J., Wieland, Donald M., Hutchins, Gary D., Wolfe, Edwin R., Greene, Douglas A., Schwaiger, Markus
Format: Article
Language:English
Subjects:
Adult
Aged
Associated diseases and complications
Autonomic Nervous System Diseases - complications
Autonomic Nervous System Diseases - diagnostic imaging
Biological and medical sciences
Blood Flow Velocity
Carbon Radioisotopes
Case-Control Studies
Diabetes Mellitus, Type 1 - diagnostic imaging
Diabetes Mellitus, Type 1 - physiopathology
Diabetes. Impaired glucose tolerance
Diabetic Neuropathies - complications
Diabetic Neuropathies - diagnostic imaging
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Ephedrine - analogs & derivatives
Female
Heart Diseases - diagnostic imaging
Heart Diseases - etiology
Humans
Male
Medical sciences
Middle Aged
Sensitivity and Specificity
Severity of Illness Index
Sympathetic Nervous System
Tomography, Emission-Computed - methods
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Summary:Objectives. The purpose of this investigation was to evaluate the sympathetic nervous system of the heart by positron emission tomographic (PET) imaging in patients with diabetes mellitus with and without diabetic autonomic neuropathy. Background. The clinical assessment of cardiac involvement in diabetic autonomic neuropathy has been limited to cardiovascular reflex testing. With the recent introduction of radiolabeled catecholamines such as carbon (C)-11 hydroxyephedrine, the sympathetic innervation of the heart can be specifically visualized with PET imaging. Methods. Positron emission tomographic imaging was performed with C-11 hydroxyephedrine and rest myocardial blood flow imaging with nitrogen-13 ammonia. Three patient groups were studied, including healthy volunteers as control subjects, diabetic patients with normal autonomic function testing and diabetic patients with varying severity of autonomic neuropathy. Homogeneity of cardiac tracer retention as well as absolute tracer retention was determined by relating myocardial tracer retention to an arterial C-11 activity input function. Results. Abnormal regional C-11 hydroxyephedrine retention was seen in seven of eight patients with autonomic neuropathy. Relative tracer retention was significantly reduced in apical, inferior and lateral segments. The extent of the abnormality correlated with the severity of conventional markers of autonomic dysfunction. Absolute myocardial tracer retention index measurements showed a 45 ± 21% decrease in distal compared with proximal myocardial segments in autonomic neuropathy (0.069 ± 0.037 min−1vs. 0.13 ± 0.052 min−1, p = 0.02). Conclusions. This study demonstrates a heterogeneous pattern of neuronal abnormalities in patients with diabetic cardiac neuropathy. The extent of this abnormality correlated with the severity of neuropathy assessed by conventional tests. Future studies in larger groups of patients are required to define the relative sensitivity of this imaging approach in detecting cardiac neuropathy and to determine the clinical significance of these scintigraphic findings in comparison with conventional markers of autonomic innervation.
ISSN:0735-1097
1558-3597
DOI:10.1016/0735-1097(93)90553-D