Scintigraphy and diabetic cardiomyopathy

Czech version

Authors: Otto Lang
Authors‘ workplace: Klinika nukleární medicíny, UK 3. LF a FNKV, Praha ¹⁰
Published in: NuklMed 2013;2:62-67
Category: Review Article

Overview

Introduction:
Scintigraphy is an optimal method for molecular imaging; therefore, it is useful for evaluation of patients with metabolic disorders. Diabetic cardiomyopathy is a heart failure without evidence of coronary atherosclerosis, hypertension or valvular disease. The cause is still not fully clarified; most probably it is multifactorial and involves metabolic changes including insulin resistance, microcirculation disorder including endothelial dysfunction, autonomic neuropathy and interstitial fibrosis.

Material and methods:
Scintigraphy makes possible to assess many pathophysiological processes that can participate in the progression of diabetic cardiomyopathy. Glucose, fatty acids and acetate can be used as substrates mainly in basal experiments. Scintigraphy can also be used to detect impairment of microcirculation with subsequent decrease of myocardial perfusion mainly in clinical practice. Labeled metabolic analogues of norepinephrine or direct labeling of catecholamines can be used for assessment of autonomous neuropathy.

Results:
Metabolic plasticity of myocardium is impaired; there is compromised glucose utilization with increased accumulation of fatty acids. Myocardial contractility is decreased due to lower energy production; lipotoxicity causes apoptosis with subsequent myocardial fibrosis. Myocardial perfusion deficit was detected in 20 % to 40 % of asymptomatic diabetics. They also have decreased vasodilatation capacity even without impairment of epicardial vessels. Regional disorder of sympathetic innervation in diabetics was also proved.

Conclusion:
Scintigraphic methods have a high diagnostic potential. They make possible timely and effective therapy. However, they should be used with caution in clinical practice and mainly in symptomatic or high-risk patients.

Key words:
scintigraphy, diabetic cardiomyopathy, glucose, fatty acids, lipotoxicity

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Nuclear medicine Radiodiagnostics Radiotherapy

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Article was published in

Nuclear Medicine

2013 Issue 4