Mj. Koistinen et al., NO DIFFERENCE IN CARDIAC INNERVATION OF DIABETIC-PATIENTS WITH PAINFUL AND ASYMPTOMATIC CORONARY-ARTERY DISEASE, Diabetes care, 19(3), 1996, pp. 231-235
Citations number
44
Categorie Soggetti
Endocrynology & Metabolism","Medicine, General & Internal
OBJECTIVE - To test the hypothesis that diabetic autonomic neuropathy
interfering with sensory impulses from the heart by sympathetic denerv
ation is the major cause of the high prevalence of asymptomatic corona
ry artery disease (CAD) in diabetic patients. RESEARCH DESIGN AND METH
ODS - We evaluated cardiac sympathetic innervation in a population-bas
ed group of 10 asymptomatic diabetic patients with angiographically pr
oven CAD and in an age- and sex-matched group of 10 diabetic patients
with symptomatic CAD using [I-123]metaiodobenzylguanide (MIBG) scintig
raphy. Exercise electrocardiography and myocardial perfusion imaging b
y Tl-201 were used to detect myocardial ischemia, and standard cardiov
ascular tests were used to diagnose autonomic nervous dysfunction. RES
ULTS - Thallium scintigraphy revealed perfusion defects in all 10 symp
tomatic patients and in 9 of the asymptomatic patients. MIBG accumulat
ion defects were found in all cases with painless and with painful dis
ease. In the asymptomatic group, the denervation area exceeded the isc
hemic area in six cases and areas with total MIBG accumulation defects
were seen in four cases. In one case, the MIBG defect was not in the
ischemic region. In the symptomatic group, the denervation area exceed
ed the area of the ischemic region in all cases and areas of total den
ervation were seen in six cases. The autonomic nervous function tests
were abnormal in two asymptomatic and three symptomatic patients with
CAD. CONCLUSIONS - Cardiac sympathetic denervation is common in both p
atients with painful CAD and patients with asymptomatic CAD regardless
of diabetic autonomic neuropathy. This finding supports the view that
sympathetic innervation of the heart is highly sensitive to ischemia
and this profound effect of ischemia masks the potential effects of au
tonomic neuropathy on sympathetic innervation. Mechanisms leading to t
he lack of ischemic pain in diabetic patients with CAD are complex and
are not solely explained by autonomic neuropathy.