Cardiac Sympathetic Dysinnervation in Type 2 Diabetes Mellitus With and Without ECG-based Cardiac Autonomic Neuropathy

J Diabetes Complications. May-Jun 2002;16(3):220-7. doi: 10.1016/s1056-8727(01)00180-5.


To evaluate the presence and extent of global and regional distributions of cardiac sympathetic dysinnervation in Type 2 diabetes mellitus I-123-metaiodobenzylguanidine (I-123-MIBG) scintigraphy was applied to 15 Type 2 (noninsulin-dependent) diabetic patients with ECG-based cardiac autonomic neuropathy (> or = two of five age-related cardiac reflex tests abnormal) and 15 clinically comparable Type 2 diabetic patients without ECG-based cardiac autonomic neuropathy. Myocardial perfusion abnormalities were excluded by 99 m-Tc-methoxyisobutylisonitrile (99 m-MIBI) scintigraphy. Both in Type 2 diabetic patients with and without, ECG-based autonomic neuropathy, only one patient (7%) was found to have a normal homogeneous uptake of I-123-MIBG compared to 14 patients (93%) with a reduced I-123-MIBG uptake. The uptake of I-123-MIBG in the posterior myocardium of diabetic patients was smaller than in the anterior, lateral, and septal myocardium (P< .001, P< .001, P< .001, respectively). Diabetic patients with ECG-based cardiac autonomic neuropathy demonstrated a more pronounced reduction of the posterior I-123-MIBG myocardial uptake than diabetic patients without (P< .01). The mean global and the anterior, lateral, septal, and apical myocardial I-123-MIBG uptake was comparable between the two groups. The uptake of the posterior myocardial region correlated with all indices of heart rate variation at rest and during deep breathing. A correlation between global or regional myocardial I-123-MIBG uptake and QT interval was not observed. The study demonstrates that cardiac sympathetic dysinnervation is common in Type 2 diabetes mellitus both with and without ECG-based cardiac autonomic neuropathy. In Type 2 diabetes mellitus, the posterior myocardium is predominantly affected and the extent of dysinnervation is more pronounced in the presence of ECG-based cardiac autonomic neuropathy.

MeSH terms

  • 3-Iodobenzylguanidine / pharmacokinetics
  • Autonomic Denervation*
  • Diabetes Mellitus, Type 2 / diagnostic imaging
  • Diabetes Mellitus, Type 2 / surgery*
  • Diabetic Neuropathies / diagnostic imaging
  • Diabetic Neuropathies / surgery*
  • Female
  • Glycated Hemoglobin A / analysis
  • Heart / diagnostic imaging
  • Heart / innervation*
  • Humans
  • Male
  • Middle Aged
  • Radionuclide Imaging
  • Radiopharmaceuticals / pharmacokinetics
  • Sympathetic Nervous System / diagnostic imaging
  • Sympathetic Nervous System / surgery*
  • Tissue Distribution


  • Glycated Hemoglobin A
  • Radiopharmaceuticals
  • 3-Iodobenzylguanidine