Document Detail


Use of iodine-123 metaiodobenzylguanidine scintigraphy to assess cardiac sympathetic denervation and the impact of hypertension in patients with non-insulin-dependent diabetes mellitus.
MedLine Citation:
PMID:  10541830     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objectives of this clinical study using iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy were (a) to evaluate cardiac sympathetic denervation in non-insulin-dependent diabetes mellitus (NIDDM) patients with and without hypertension and (b) to investigate the relation between cardiac sympathetic denervation and prognosis in NIDDM patients. We compared clinical characteristics and MIBG data [heart to mediastinum (H/M) ratio and % washout rate (WR)] in a control group and NIDDM patients with and without hypertension. MIBG scintigraphy was performed in 11 controls and 82 NIDDM patients without overt cardiovascular disease except for hypertension (systolic blood pressure >/=140 and/or diastolic blood pressure >/=90 mmHg). After MIBG examination, blood pressure was measured regularly in all NIDDM patients. There were significant differences between 65 normotensive and 17 hypertensive NIDDM patients with respect to age (55+/-11 vs 63+/-12 years, respectively, P<0.05), prevalence of diabetic retinopathy (12% vs 35%, respectively, P<0.05) and systolic blood pressure (120+/-12 vs 145+/-16 mmHg, respectively, P<0.001). The H/M ratio in hypertensive NIDDM patients was significantly lower than in the control group (1. 81+/-0.29 vs 2.27+/-0.20, respectively, P<0.01). During the follow-up period (18+/- 12 months), 17 NIDDM patients newly developed hypertension after MIBG examination. There were no significant differences in their clinical characteristics compared with persistently normotensive or hypertensive NIDDM patients. %WR in patients with new onset hypertension was significantly higher than in the control group (30.88%+/-16.87% vs 12.89%+/-11.94%, respectively, P<0.05). Moreover, in these patients %WR correlated with duration from the date of MIBG scintigraphy to the onset of hypertension (r=-0.512, P<0.05). Five NIDDM patients died during the follow-up period (four newly hypertensive patients and one normotensive patient). There were significant statistical differences between the control group and non-survivors in terms of age (54+/-11 vs 73+/-11 years, respectively, P<0.01), H/M ratio (2. 27+/- 0.20 vs 1.64+/-0.36, respectively, P<0.01) and %WR (12. 89%+/-11.94% vs 42.52%+/-22.39%, respectively, P<0.01). In conclusion, cardiac sympathetic denervation using MIBG scintigraphy observed in hypertensive NIDDM patients, and was more profound in non-survivors. MIBG scintigraphy proved useful for the evaluation of NIDDM patients with new onset hypertension, and it was found that NIDDM patients with abnormalities on MIBG scintigraphy needed to be observe carefully.
Authors:
K Tamura; K Utsunomiya; Y Nakatani; Y Saika; S Onishi; T Iwasaka
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  European journal of nuclear medicine     Volume:  26     ISSN:  0340-6997     ISO Abbreviation:  Eur J Nucl Med     Publication Date:  1999 Oct 
Date Detail:
Created Date:  2000-02-17     Completed Date:  2000-02-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7606882     Medline TA:  Eur J Nucl Med     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  1310-6     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Keihanna Hospital, Hirakata City, Osaka, Japan.
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MeSH Terms
Descriptor/Qualifier:
3-Iodobenzylguanidine / diagnostic use*
Adult
Aged
Aged, 80 and over
Autonomic Nervous System Diseases / etiology*,  radionuclide imaging*
Blood Pressure / drug effects,  physiology
Body Mass Index
Diabetes Mellitus, Type 2 / complications*,  radionuclide imaging*
Female
Follow-Up Studies
Heart / innervation*,  radionuclide imaging*
Hemoglobin A / metabolism
Humans
Hypertension / etiology*,  radionuclide imaging*
Male
Middle Aged
Prognosis
Radiopharmaceuticals / diagnostic use*
Sympathetic Nervous System / radionuclide imaging*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 77679-27-7/3-Iodobenzylguanidine; 9034-51-9/Hemoglobin A

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