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

Kevin C. Allman, Martin J. Stevens, Donald M. Wieland, Gary Hutchins, Edwin R. Wolfe, Douglas A. Greene, Markus Schwaiger

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

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-1 vs. 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.

Original languageEnglish (US)
Pages (from-to)1425-1432
Number of pages8
JournalJournal of the American College of Cardiology
Volume22
Issue number5
DOIs
StatePublished - Nov 1 1993
Externally publishedYes

Fingerprint

Diabetic Neuropathies
Positron-Emission Tomography
Carbon
Electrons
Sympathetic Nervous System
Ammonia
Catecholamines
Reflex
Diabetes Mellitus
Healthy Volunteers
Nitrogen

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Noninvasive assessment of cardiac diabetic neuropathy by carbon-11 hydroxyephedrine and positron emission tomography. / Allman, Kevin C.; Stevens, Martin J.; Wieland, Donald M.; Hutchins, Gary; Wolfe, Edwin R.; Greene, Douglas A.; Schwaiger, Markus.

In: Journal of the American College of Cardiology, Vol. 22, No. 5, 01.11.1993, p. 1425-1432.

Research output: Contribution to journalArticle

Allman, Kevin C. ; Stevens, Martin J. ; Wieland, Donald M. ; Hutchins, Gary ; Wolfe, Edwin R. ; Greene, Douglas A. ; Schwaiger, Markus. / Noninvasive assessment of cardiac diabetic neuropathy by carbon-11 hydroxyephedrine and positron emission tomography. In: Journal of the American College of Cardiology. 1993 ; Vol. 22, No. 5. pp. 1425-1432.
@article{32781db1679c4b96b945ca6af797cdaa,
title = "Noninvasive assessment of cardiac diabetic neuropathy by carbon-11 hydroxyephedrine and positron emission tomography",
abstract = "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-1 vs. 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.",
author = "Allman, {Kevin C.} and Stevens, {Martin J.} and Wieland, {Donald M.} and Gary Hutchins and Wolfe, {Edwin R.} and Greene, {Douglas A.} and Markus Schwaiger",
year = "1993",
month = "11",
day = "1",
doi = "10.1016/0735-1097(93)90553-D",
language = "English (US)",
volume = "22",
pages = "1425--1432",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Noninvasive assessment of cardiac diabetic neuropathy by carbon-11 hydroxyephedrine and positron emission tomography

AU - Allman, Kevin C.

AU - Stevens, Martin J.

AU - Wieland, Donald M.

AU - Hutchins, Gary

AU - Wolfe, Edwin R.

AU - Greene, Douglas A.

AU - Schwaiger, Markus

PY - 1993/11/1

Y1 - 1993/11/1

N2 - 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-1 vs. 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.

AB - 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-1 vs. 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.

UR - http://www.scopus.com/inward/record.url?scp=0027368404&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027368404&partnerID=8YFLogxK

U2 - 10.1016/0735-1097(93)90553-D

DO - 10.1016/0735-1097(93)90553-D

M3 - Article

C2 - 8227801

AN - SCOPUS:0027368404

VL - 22

SP - 1425

EP - 1432

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

ER -