Sympathetic Innervation and Blood Flow in the Diabetec Heart

  • Oliver Schnell
Part of the Advances in Behavioral Biology book series (ABBI, volume 53)


The balance of the activity of the cardiac sympathetic and parasympathetic nervous system plays a key role for the functional and structural performance of the diabetic heart.1 Metabolic, vascular/hemorrheological and, in type 1 diabetes mellitus, immunological factors are currently hypothezised to contribute to the pathogenesis, which, however, has not been fully elucidated.1 The heterogeneous pattern and the high extent of dysfunction of the cardiac sympathetic nervous system in diabetes mellitus had remained largely unknown until advanced scintigraphic techniques for direct characterization of dysfunction of sympathetic neurons in the living heart emerged in the 1990’s. Previously, diagnosis of cardiac sympathetic abnormalities had been mainly based on conventional non-invasive cardiac reflex tests, including measurements of heart rate variation and blood pressure changes to standing. These tests, however, only indirectly assess diabetic cardiac autonomic dysfunction, they do not differentiate absolutely between sympathetic and parasympathetic function and they do not assess the heart regionally. Imbalance of the activity of the cardiac sympathetic nervous system is suggested to lead to multiple functional disturbances and to increase the risk for arrythmogenicity of the diabetic heart.2


Myocardial Blood Flow Sympathetic Ganglion Diabetic Heart Cardiac Autonomic Neuropathy Cardiac Sympathetic Innervation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    E. Standi, O. Schnell. A new look upon the heart in diabetes mellitus: from ailing to failing. Diabetologia 43: 1455–1469 (2000)CrossRefGoogle Scholar
  2. 2.
    O. Schnell, C.-M. Kirsch, J. Stemplinger, M. Haslbeck, E. Standi. Scintigraphic evidence for cardiac sympathetic dysinnervation in long-term Type 1 diabetic patients with and without ECG-based autonomic neuropathy. Diabetologia 38:1345–1352 (1995)PubMedCrossRefGoogle Scholar
  3. 3.
    M. Mäntysaari, J. Kuikka, J. Mustonen, K. Tahvanainen, E. Vanninen, E. Länsimies, M. Uusitupa: Noninvasive detection of cardiac sympathetic nervous dysfunction in diabetic patients using (123I) metaiodobenzylguanidine. Diabetes 41: 1069–1075 (1992)PubMedCrossRefGoogle Scholar
  4. 4.
    A. Langer, M.R. Freeman, R.G. Josse, P.W. Armstrong: Metaiodobenzylguanidine imaging in diabetes mellitus: Assessment of cardiac sympathetic dysinnervation and its relation to autonomic dysfunction and silent myocardial ischemia. J Am Coll Cardiol 25: 610–618 (1995)PubMedCrossRefGoogle Scholar
  5. 5.
    O. Schnell, D. Muhr, M. Weiss, S. Dresel, M. Haslbeck, E. Standi. Reduced myocardial 123I-metaiodobenzylguanidine uptake in newly diagnosed IDDM patients. Diabetes 45:801–805 (1996)PubMedCrossRefGoogle Scholar
  6. 6.
    M.A. Pfeifer, M.P. Schumer: Perspectives in Diabetes: Clinical trials of diabetic neuropathy: past, present, and future: Diabetes 44: 1355–1361 (1995)PubMedCrossRefGoogle Scholar
  7. 7.
    O. Schnell, D. Muhr, S. Dresel, M. Weiss, M. Haslbeck, E. Standi. Partial restoration of scintigraphically assessed cardiac sympathetic denervation in newly diagnosed patients with insulin dependent (Type 1) diabetes mellitus at one-year follow-up. Diabetic Medicine 14:57–62 (1997)PubMedCrossRefGoogle Scholar
  8. 8.
    D. Muhr-Becker, M. Weiss, K. Tatsch, G. Wolfram, E. Standi, O. Schnell. Scintigraphically assessed cardiac sympathetic dysinnervation in poorly controlled type 1 diabetes mellitus: One-year follow-up with improved metabolic control. Exp Clin Endocrinol Diabetes 107:306–312 (1999)PubMedCrossRefGoogle Scholar
  9. 9.
    O. Schnell, D. Muhr, M. Weiss, C.M. Kirsch, M. Haslbeck, E. Standi. Three-year follow-up on scintigraphically assessed cardiac sympathetic denervation in patients with long-term Insulin Dependent (Type 1) Diabetes mellitus. J Diab Compl, 11:307–313 (1997)CrossRefGoogle Scholar
  10. 10.
    K.C. Allman, M.J. Stevens, D.M. Wieland, G.D. Hutchins, E.R. Wolfe, D.A. Greene, M. Schwaiger. Noninvasive assessment of cardiac diabetic neuropathy by C11 hydroxyephedrine and positron emission tomography. J Am Coll Cardiol 22: 1425–1432 (1993)PubMedCrossRefGoogle Scholar
  11. 11.
    M.J. Stevens, D.M. Raffel, K.C. Allman, F. Dayanikli, E. Ficaro, T. Sandford, D.M. Wieland, M.A. Pfeifer, M. Schwaiger et al. Cardiac sympathetic dysinnervation in diabetes. Circulation 98: 961–968 (1998)PubMedCrossRefGoogle Scholar
  12. 12.
    O. Schnell, D. Muhr, S. Dresel, K. Tatsch, A.G. Ziegler, M. Haslbeck, E Standi. Autoantibodies against sympathetic ganglia and evidence of cardiac sympathetic dysinnervation in newly diagnosed and long- term IDDM patients. Diabetologia 39:970–975 (1996)CrossRefGoogle Scholar
  13. 13.
    D. Muhr, U. Mollenhauer, A. Ziegler, M. Haslbeck, E. Standi, O. Schnell. Autoantibodies to sympathetic ganglia, GAD, or tyrosine phosphatase in long-term IDDM with and without ECG-based cardiac autonomic neuropathy. Diabetes Care 20:1009–1012 (1997)PubMedCrossRefGoogle Scholar
  14. 14.
    O. Schnell, A. Schwarz, D. Muhr-Becker, E. Standi: Cardiac autonomic dysfunction in Type 2 Diabetes mellitus: No association with autoantibodies against autonomic nervous tissues. Exp Clin Endocrinol Diabetes 108: 181–186 (2000)PubMedCrossRefGoogle Scholar
  15. 15.
    M. Schwaiger, J. Melin. Cardiological applications of nuclear medicine. Lancet 354: 661–666 (1999)PubMedCrossRefGoogle Scholar
  16. 16.
    M.F. Di Carli, D. Bianco-Batlles, M.E. Landa, A. Kazmers, H. Groehn, O. Muzik, G. Grunberger. Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus. Circulation 100: 813–819 (1999)PubMedCrossRefGoogle Scholar
  17. 17.
    A.M. Zeiher, H. Drexler, H. Wollschlager, B. Saurbier, H Just. Coronary vasomotion in response to sympathetic stimulation in humans: importance of the functional integrity of the endothelium. J Am Coll Cardiol 14: 1181–1190(1989)PubMedCrossRefGoogle Scholar
  18. 18.
    M.R. Kichuk, N. Seyedi, X Zhang et al. Regulation of nitric oxide production in human coronary microvessels and the contribution of local kinin formation. Circulation 94:44–51 (1996)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Oliver Schnell
    • 1
  1. 1.Diabetes Reseach Institute MunichMunichGermany

Personalised recommendations