ISSN:
1432-0428
Schlagwort(e):
Keywords Diabetic cardiovascular autonomic neuropathy
;
MIBG scintigraphy
;
sympathetic denervation
;
autonomic function tests
;
glycaemic control.
Quelle:
Springer Online Journal Archives 1860-2000
Thema:
Medizin
Notizen:
Summary Diabetic cardiovascular autonomic neuropathy (CAN) has been directly characterized by reduced or absent myocardial [123I]metaiodobenzylguanidine (MIBG) uptake, but there is no information available on the relationship between the myocardial adrenergic innervation defects and long-term glycaemic control. In a prospective study over a mean of 4 years we examined myocardial sympathetic innervation in 12 Type 1 (insulin-dependent) diabetic patients using MIBG scintigraphy (absolute and relative global MIBG uptake at 2 h p. i.) in conjunction with cardiovascular autonomic function tests, QTc interval, and QT dispersion. Six healthy non-diabetic subjects served as controls for the MIBG scintigraphy at baseline. HbA1c was measured twice a year. One patient, in whom MIBG accumulation was reduced maximally, died during follow up. Among the remaining patients 5 had good or borderline glycaemic control (mean HbA1c 〈 7.6 %; Group 1), whereas 6 patients were poorly controlled (mean HbA1c L 7.6 %; Group 2). Absolute global MIBG uptake increased from baseline to follow-up by 260 (−190–540) [median (range) ] cpm/g in Group 1 and decreased by −150 (−450–224) cpm/g in Group 2 (p 〈 0.05 vs Group 1). Relative global MIBG uptake decreased by −1.7 (−3.4–9.4) % in Group 1 and by −4.7 (−17.4–1.3) % in Group 2 (p 〈 0.05 vs Group 1). No differences between the groups were noted for the changes in the automatic function tests, QTc interval, and QT dispersion. In conclusion, long-term poor glycaemic control constitutes an essential determinant in the progression of left ventricular adrenergic dysinnervation which may be prevented by near-normoglycaemia. Evaluation of susceptibility to metabolic intervention may be superior when CAN is characterized directly by MIBG scintigraphy rather than by indirect autonomic function testing. [Diabetologia (1998) 41: 443–451]
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1007/s001250050928
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