Impact of diabetes on cardiac sympathetic innervation in patients with heart failure: A 123I meta-iodobenzylguanidine (123I MIBG) scintigraphic study

Stefania Paolillo, Giuseppe Rengo, Gennaro Pagano, Teresa Pellegrino, Gianluigi Savarese, Grazia D. Femminella, Marianna Tuccillo, Antonio Boemio, Emilio Attena, Roberto Formisano, Laura Petraglia, Francesco Scopacasa, Gennaro Galasso, Dario Leosco, Bruno Trimarco, Alberto Cuocolo, Pasquale Perrone-Filardi

Research output: Contribution to journalArticlepeer-review


OBJECTIVE-Impaired parasympathetic and sympathetic nervous system activity have been demonstrated in patients with diabetes mellitus (DM) and correlated with worse prognosis. Few data are available on the effect of DM on cardiac neuropathy in heart failure (HF). The aim of the current study was to assess cardiac sympathetic activity in HF patients with and without DM. RESEARCH DESIGN AND METHODS-Patients with severe HF (n = 75), with (n = 37) and without DM (n = 38), and 14 diabetic patients with normal cardiac function underwent 123I meta-iodobenzylguanidine scintigraphy from which early and late heart-to-mediastinum (H/M) ratios were calculated. Clinical, echocardiographic, and biochemical data were measured. RESULTS-DM compared with non-DM patients showed significantly lower early (1.65±0.21 vs. 1.75 ± 0.21; P <0.05) and late H/M ratios (1.46 ± 0.22 vs. 1.58 ± 0.24; P <0.03). Early and late H/M were significantly higher in DM patients without HF (2.22 ± 0.35 and 1.99 ± 0.24, respectively) than HF patients with (P1c (HbA1c) (Pearson =20.473, P = 0.001;Pearson =20.382, P = 0.001, respectively) was observed. InDM, inmultivariate analysis, HbA1c and ejection fraction remained significant predictors of early H/M; HbA1c remained the only significant predictor of late H/M. No correlation between early or late H/M and HbA1c was found in non-DM patients. CONCLUSIONS-Diabetic patients with HF show lower cardiac sympathetic activity than HF patients not having DM or than DM patients with a similar degree of autonomic dysfunction not having HF. HbA1c correlated with the degree of reduction in cardiac sympathetic activity.

Original languageEnglish
Pages (from-to)2395-2401
Number of pages7
JournalDiabetes Care
Issue number8
Publication statusPublished - 2013

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing
  • Medicine(all)

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