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DOI: 10.1055/s-2002-26736
Szintigraphische Charakterisierung von Blutflussregulation und sympathischer Funktion des Herzens bei Diabetikern
Scintigraphic assessment of blood flow regulation and sympathetic function of the diabetic heartPublication History
7.1.2002
22.2.2002
Publication Date:
02 May 2002 (online)
![](https://www.thieme-connect.de/media/dmw/200218/lookinside/thumbnails/10.1055-s-2002-26736-1.jpg)
Das Ungleichgewicht zwischen sympathischer und parasympathischer Nervenfunktion spielt bei Diabetes mellitus mit Blick auf die funktionale und strukturelle Leistungsfähigkeit des Herzens eine wichtige Rolle und trägt mit zur hohen kardialen Mortalität bei Diabetes bei [42]. Metabolische, vaskulär/hämorheologische und, bei Typ-1-Diabetes, immunologische Faktoren sind an der Entstehung der kardialen sympathischen Dysfunktion, deren einzelne Schritte bis heute noch nicht geklärt werden konnte [33] [35] [42], beteiligt. Das heterogene Muster der kardialen Dysfunktion, ihre Prädominanz im Bereich der Herzhinterwand und das Ausmaß der kardialen sympathischen Dysfunktion bei Diabetes mellitus [34] [37], waren bis zur Einführung szintigraphischer Methoden wie SPECT und PET im letzten Jahrzehnt, durch die das kardiale sympathische Nervensystem direkt untersucht wird, weitgehend unbekannt. Zuvor standen allein EKG-basierte kardiale Funktionstests zur Diagnose einer kardialen autonomen Neuropathie zur Verfügung. Diese haben ihren hohen Stellenwert in der Diagnostik beibehalten, auch da sie einfach durchführbar und ihre Ergebnisse gut reproduzierbar sind [35]. Dennoch können frühe kardiale autonome Funktionsstörungen durch diese Tests meist nicht erkannt werden, da sie die Funktion des kardialen autonomen Nervensystems nur indirekt aufzeigen [35]. Im Folgenden wird das szintigraphisch detektierbare Muster der kardialen sympathischen Dysinnervation bei Diabetes vorgestellt, wobei auch auf pathophysiologische Mechanismen eingegangen wird. Das heutige Wissen zum koronaren Blutfluss des Diabetikers und die Beziehungen zur autonomen Dysfunktion werden aufgezeigt.
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Priv.-Doz. Dr. med. Oliver Schnell
Institut für Diabetesforschung
Kölner
Platz 1
80804 München
Phone: 0049-89-38380700
Fax: 0049-89-38380701
Email: Oliver.Schnell@lrz.uni-muenchen.de