Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of 123I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability |
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Authors: | Arthur J H A Scholte Joanne D Schuijf Victoria Delgado Jurriaan A Kok Mieke T J Bus Arie C Maan Marcel P Stokkel Antje V Kharagitsingh Petra Dibbets-Schneider Ernst E van der Wall Jeroen J Bax |
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Institution: | 1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box?9600, 2300 RC, Leiden, the Netherlands 2. Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands 3. Department of Internal Medicine, Medisch Centrum Haaglanden, The Hague, The Netherlands
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Abstract: | Purpose The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and 123I-metaiodobenzylguanidine (123I-mIBG) myocardial scintigraphy. Methods The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and 123I-mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by 123I-mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was <1.8, the washout rate was >25%, or the total defect score was >13. Results The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and 123I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, 123I-mIBG scintigraphy showed CAN. Conclusion The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and 123I-mIBG scintigraphy for the assessment of CAN was observed. |
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