technetium-tc-99m-tetrofosmin and Diabetic-Angiopathies

We investigated efficacy and safety of implantation of autologous bone marrow mononuclear cells plus platelets, including endothelial progenitor cells (EPCs), for recovering refractory chronic peripheral arterial disease (PAD) using visual and quantitative analyses by 99mTc-tetrofosmin (TF) perfusion scintigraphy, and also investigated various quantitative assessments objectively. We performed 12 consecutive cases and 19 limbs and hands with severe chronic PAD that were almost Fontaine class IV (11/12 cases, about 92%) in this trial. This treatment was very effective in relieving severe pain of PAD, especially for Buerger's disease. We used a visual analog scale (VAS) for measurement of pain level. The maximum pain level before implantation was 66.5+/-5.0 mm, and it decreased to 12.1+/-2.2 mm after implantation (p < 0.001). Rest pain in legs and fingers was resolved in 11 cases (11/12 cases, 92%). All patients could measure pain-free walking time on a treadmill, which improved remarkably (140+/-53 s before implantation vs. 451+/-74 s after implantation, p = 0.034). Resting ankle brachial pressure index (ABI) in legs implanted with bone marrow mononuclear cells was also improved (0.65+/-0.08 before implantation vs. 0.73+/-0.07 after implantation, p = 0.055). According to 99mTc-TF perfusion scintigraphy, the proximal area (region from knee to ankle) was 1.32+/-0.10 before implantation versus 1.56+/-0.11 after implantation (p = 0.007). 99Tc-TF perfusion scintigraphy in the distal area (region from ankle to end of toes, or from wrist to end of fingers) was 0.79+/-0.06 before implantation versus 0.83+/-0.06 after implantation (p = 0.29). Ischemic legs and hands that were injected showed increased perfusion blood flow. 99mTc-TF perfusion scintigraphy was effective to estimate visual and quantitative analysis of collateral vessels in neovascularization. We were successful with this new treatment for the most severe, chronic PAD that was not curable by any of the current treatments. Thus, this therapeutic angiogenesis could be a new strategy for saving severe ischemic limbs and hands.

Topics: Aged; Arteriosclerosis Obliterans; Bone Marrow Cells; Bone Marrow Transplantation; Chronic Disease; Diabetic Angiopathies; Female; Gangrene; Humans; Male; Middle Aged; Neovascularization, Physiologic; Organophosphorus Compounds; Organotechnetium Compounds; Peripheral Vascular Diseases; Radionuclide Imaging; Radiopharmaceuticals; Thromboangiitis Obliterans

Incidence of early myocardial changes in asymptomatic diabetic individuals is not clearly documented. In the present study, we examined diabetic patients without a history of cardiovascular disease with negative treadmill test and no signs of systolic dysfunction for presence of cardiac autonomic neuropathy established by measurement of heart rate variability (HRV) and (99m)Tc - Myoview gated-SPET.. 47 type I and type II diabetic patients were subjected to prospective study including echocardiography and HRV measurement using the combination of Ewing´s testing and spectral analysis. Subsequently, patients underwent treadmill test and stress myocardial perfusion scintigraphy. Additionally, vascular and metabolic parameters were collected.. Treadmill test was negative in all patients. Diastolic dysfunction was found in 10 % of T1DM and 11 % of T2DM patients by echocardiography, whereas none of the patients had systolic dysfunction. SPET confirmed hypoperfusion in 35 % T1DM (p=0.01) and in 60 % T2DM (p=0.001). Diagnosis of cardiac autonomic neuropathy based on Ewing´s testing and HRV examination was established in 60 % of T1DM patients (p=0.001) and 77 % of T2DM patients (p=0.001). In T1DM group, significant association was found between cardiac autonomic neuropathy (CAN) and frequency of hypoglycaemia (p=0.04). No such correlations were found in patients with T2DM.. The results of the present study show high incidence of myocardial hypoperfusion and cardiac autonomic neuropathy among asymptomatic diabetic patients, whereas the standard diagnostic approaches including treadmill test and echocardiography failed to show any changes. Therefore, we conclude that diabetic heart disease remains underdiagnosed by standard approaches, but could be detected in asymptomatic patients by more sensitive methods, such as HRV measurement and myocardial scintigraphy (Tab. 2, Fig. 2, Ref. 26).

Topics: Adult; Asymptomatic Diseases; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Neuropathies; Female; Heart; Heart Rate; Humans; Male; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiography; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

Diabetes is associated with abnormal function of the autonomic nervous system, while autonomic dysfunction is related to attenuated heart-rate recovery (HRR) after exercise testing. The purpose of this study was to test whether HRR could be a useful index of myocardial ischaemia in patients suffering from diabetes mellitus.. We included 206 consecutive patients in this study and excluded patients whose HRR value or the myocardial perfusion imaging could have been influenced by factors other than myocardial ischaemia. The value of HRR was defined as the decrease in the heart rate from peak exercise to 1 min after the termination of the exercise. All patients underwent SPECT myocardial perfusion imaging, combined with exercise testing and we calculated the summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) indexes.. Sixty patients had abnormal HRR value. A significant correlation was found between HRR 1 min after exercise and SSS (r=-0.64, P<0.001), SDS (r=0.56, P<0.001) and chronotropic variables. Patients with abnormal HRR value, had a higher frequency of other risk factors (besides diabetes) for CAD, were mostly taking cardioactive medications, had lower efficiency during treadmill testing, and presented more pathologic findings on the scintigram.. Our results suggest that myocardial ischaemia, as it is mainly assessed by myocardial perfusion imaging, has an important correlation with HRR in diabetic patients. HRR value 1 min after exercise may be considered as a useful index of the severity of myocardial ischaemia, in this cohort of patients.

Topics: Adult; Aged; Algorithms; Cohort Studies; Coronary Circulation; Diabetes Mellitus; Diabetic Angiopathies; Exercise; Exercise Test; Female; Heart; Heart Rate; Humans; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Regression Analysis; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Global and regional myocardial uptake was determined with technetium-99m tetrofosmin and a 4 hour exercise (370 MBq i.v.) and rest (740 MBq i.v.) protocol, in 24 patients with non-insulin dependent diabetes mellitus and in 22 control subjects. The purpose of this study was to evaluate impaired coronary microvascular function in diabetics by measurement of % uptake increase in myocardial counts. The parameter of % uptake increase (deltaMTU) was calculated as the ratio of exercise counts to rest myocardial counts with correction of myocardial uptake for dose administered and physical decay between the exercise study and the rest study. Global deltaMTU was significantly lower in the diabetics than in control subjects (14.4 +/- 5.4% vs. 21.7 +/- 8.5%, p < 0.01). Regional deltaMTU in each of 4 left ventricular regions (anterior, septal, inferior, posterolateral) was significantly lower in the diabetic group than in the control group (p < 0.01) respectively, but there were no significant differences between deltaMTU in the 4 left ventricular regions in the same group. deltaMTU was useful as a non-invasive means of evaluating impaired coronary microvascular function in diabetics.

Topics: Blood Pressure; Coronary Circulation; Coronary Disease; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Exercise Test; Female; Heart; Heart Rate; Hemodynamics; Humans; Male; Microcirculation; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reference Values; Regression Analysis; Tissue Distribution; Tomography, Emission-Computed, Single-Photon