Relation of Direct Assessment of Cardiac Autonomic Function With Metaiodobenzylguanidine Imaging to Heart Rate Variability in Diabetes Mellitus

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Acknowledgements

We acknowledge the research assistance of Heather Hink, RN, the expert technical support of Lois Adams, BSc, Terry Hsia, RT, BSc, and the secretarial assistance of Tami Gallivan.

This study was supported in part by the Canadian Diabetes Association, Toronto, Ontario, Canada.

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    To obtain the highest sensitivity and specificity it has been suggested that a reliable approach to APN diagnosis include a combination of various autonomic tests in the composite autonomic scoring scale (CASS), which includes QSART, orthostatic blood pressure, heart rate response to tilt, heart rate response to deep breathing, the Valsalva ratio, and beat-to-beat blood pressure measurements during phases II and IV of the Valsalva maneuver, tilt, and deep breathing (Low 1993, 2003b). Furthermore, quantitative scintigraphic assessment of sympathetic innervation of the human heart is possible with positron emission tomography (PET) and either [123I]meta-iodobenzylguanidine (MIBG) or [11C]-meta-hydroxy-ephedrine ([11C]HED) (Goldstein et al., 1990; Freeman et al., 1997; Raffel and Wieland, 2001). These functional imaging techniques are very promising providing direct, non-invasive and quantitative information of sympathetic cardiac innervation.

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