Strengths and weaknesses of diagnostic methods of nuclear medicine in diabetic cardiomyopathy in experiment and in clinical practice
Abstract
Diabetic cardiomyopathy is usually defined as a heart failure without evidence of coronary atherosclerosis, hypertension or valvular disease. The cause is still not fully clarified; most probably it is multifactorial.
Scintigraphy is an optimal method for imaging intracellular processes on the molecular level. Glucose, fatty acids and acetate can be used as substrates.
Scintigraphy can also be used to detect endothelial dysfunction together with impairment of microcirculation with subsequent decrease of myocardial perfusion. Labeled metabolic analogues of norepinephrin or direct labeling of catecholamines can be used for assessment of autonomous neuropathy.
Metabolic plasticity of myocardium is impaired; there is compromised glucose utilization with increased accumulation of fatty acids. Myocardial perfusion deficit was detected in 20% to 40% of asymptomatic diabetics.
Regional disorder of sympathetic innervation in diabetics was also proved. Scintigraphic methods have a high diagnostic potential both in clinical and in experimental conditions.
They are able to detect a number of pathophysiological changes which can play a role in the development of diabetic cardiomyopathy and thus make possible timely and effective therapy. The main disadvantage is a relative unavailability and a high price of some methods