To assess the agreement between clinical cardiovascular adrenergic function and cardiac adrenergic innervation in type 2 diabetes patients (T2D). Thirty-three patients with T2D were investigated bimodally through (1) a standardized clinical cardiovascular adrenergic assessment, evaluating adequacy of blood pressure responses to the Valsalva maneuver and (2) I-meta-iodobenzylguanidine (MIBG) scintigraphy assessing myocardial adrenergic innervation measured as early and delayed heart heart/mediastinum (H/M) ratio, and washout rate (WR). T2D patients had significantly lower early and delayed H/M-ratios, and lower WR, compared to laboratory specific reference values. Thirteen patients had an abnormal adrenergic composite autonomic severity score (CASS > 0). Patients with abnormal CASS scores had significantly higher early H/M ratios (1.76 [1.66–1.88] vs. 1.57 [1.49–1.63], < 0.001), higher delayed H/M ratios (1.64 [1.51:1.73] vs. 1.51 [1.40:1.61] ( = 0.02)), and lower WR (−0.13(0.10) vs −0.05(0.07), = 0.01). Lower Total Recovery and shorter Pressure Recovery Time responses from the Valsalva maneuver was significantly correlated to lower H/M early ( = 0.55, = 0.001 and r = 0.5, = 0.003, respectively) and lower WR for Total Recovery ( = −0.44, = 0.01). The present study found impairment of sympathetic innervation in T2D patients based on parameters derived from MIBG cardiac scintigraphy (low early H/M, delayed H/M, and WR). These results confirm prior studies. We found a mechanistically inverted relationship with favourable adrenergic cardiovascular responses being significantly associated unfavourable MIBG indices for H/M early and delayed. This paradoxical relationship needs to be further explored but could indicate adrenergic hypersensitivity in cardiac sympathetic denervated T2D patients.

中文翻译：

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糖尿病心脏肾上腺素能功能障碍的功能性和 123I-MIBG 闪烁扫描评估


评估 2 型糖尿病患者 (T2D) 的临床心血管肾上腺素能功能与心脏肾上腺素能神经支配之间的一致性。通过以下方式对 33 名 T2D 患者进行双模式研究：(1) 标准化临床心血管肾上腺素能评估，评估血压对 Valsalva 动作的反应是否充分；(2) I-间碘苄胍 ​​(MIBG) 闪烁扫描术评估尽早测量的心肌肾上腺素能神经支配延迟心脏/纵隔 (H/M) 比率和冲洗率 (WR)。与实验室特定参考值相比，T2D 患者的早期和延迟 H/M 比以及 WR 均显着较低。 13 名患者的肾上腺素能综合自主神经严重程度评分异常 (CASS > 0)。 CASS 评分异常的患者早期 H/M 比率显着较高（1.76 [1.66–1.88] vs. 1.57 [1.49–1.63]，< 0.001），较高的延迟 H/M 比率（1.64 [1.51:1.73] vs. 1.51 [ 1.40:1.61] ( = 0.02))，并降低 WR (−0.13(0.10) 与 −0.05(0.07), = 0.01)。 Valsalva 动作的较低总恢复和较短的压力恢复时间响应与早期较低的 H/M（分别为 = 0.55，= 0.001 和 r = 0.5，= 0.003）和较低的总恢复 WR（= -0.44，= 0.01）。本研究根据 MIBG 心脏闪烁扫描参数（低早期 H/M、延迟 H/M 和 WR）发现 T2D 患者交感神经支配受损。这些结果证实了之前的研究。我们发现，有利的肾上腺素能心血管反应与早期和延迟的 H/M 的不利 MIBG 指数显着相关，这在机制上是倒置的关系。 这种矛盾的关系需要进一步探讨，但可能表明心脏交感神经失活的 T2D 患者存在肾上腺素能超敏反应。