Combined Assessment of Baroreflex Sensitivity With Iodine 123 Metaiodobenzylguanidine Scintigraphic Findings Strengthens the Power of Predictive Value for Cerebral and Cardiovascular Events in Type 2 Diabetic Patients

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Background: We previously reported that baroreflex sensitivity (BRS) or cardiac iodine 123 metaiodobenzylguanidine (123I-MIBG) scintigraphic findings can predict cardiovascular prognosis in type 2 diabetic patients. We therefore tested the hypothesis that the combination of BRS and 123I-MIBG scintigraphic findings could strengthen the predictive power for major adverse cerebral and cardiovascular events (MACCE). Methods and Results: From 1998, we have evaluated both BRS and 123I-MIBG scintigraphy in 165 type 2 diabetic patients (77 females, 88 males, mean age 59±12 years). Based on the ROC curves, depressed BRS was defined as <5.63mmHg/s, and enhanced washout ratio (WR) was defined as ≥41.4%. Each patient was divided into 3 groups based on the “BRS-MIBG combination score” as follows: 0, patients having both preserved BRS and preserved WR; 1, patients having either depressed BRS or enhanced WR; 2, patients having both depressed BRS and enhanced WR. During the mean of 4.7±2.7 years of follow-up, 19 patients developed MACCE. The MACCE-free ratio was significantly higher in the lower BRS-MIBG combination score group (log-rank 16.41, P=0.0003). Cox proportional hazards regression analysis revealed that BRS-MIBG combination score was independently associated with the incidence of MACCE (hazard ratio 4.06, P=0.0237). Conclusions: Our results suggest that combined assessment of the BRS and 123I-MIBG scintigraphic findings is more useful for identifying the type 2 diabetic patients at high risk for MACCE.

Combined Assessment of Baroreflex Sensitivity With Iodine 123 Metaiodobenzylguanidine Scintigraphic Findings Strengthens the Power of Predictive Value for Cerebral and Cardiovascular Events in Type 2 Diabetic Patients

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