Johann Malte Enno Jende1, Stefan Kopf2, Zoltan Kender2, Artur Hahn1, Jakob Morgenstern3, Peter Paul Nawroth2, Martin Bendszus1, and Felix Tobias Kurz1
1Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany, 2Internal Medicine I / Endocrinology, Heidelberg University Hospital, Heidelberg, Germany, 3Laboratory medicine, Heidelberg University Hospital, Heidelberg, Germany
Synopsis
Diabetic neuropathy (DN) is one of the most severe complications of Diabetes mellitus. This study sought to investigate potential correlations between high sensitivity Troponin T (hsTNT) assays and peripheral nerve fractional anisotropy (FA) in diffusion tensor imaging (DTI) in 51 patients with diabetes. We found negative correlations of hsTNT with the sciatic nerve's FA (r=-0.52;p<0.001) and sural, tibial, and peroneal nerve conduction velocities (0.65,p<0.001; r=-0.44,p=0.002, and r=-0.42,p=0.003, respectively). Our results indicate that hsTNT is a potential marker for microangiopathy-related nerve damage in diabetic neuropathy.
Intruduction
Diabetic neuropathy (DN) is one of the most severe and most prevalent complications of diabetes mellitus. The underlying pathophysiology of DN remains poorly understood and reliable serological markers for disease progression are not yet available. Clinical studies have suggested that changes in peripheral nerve microcirculation may contribute to nerve damage in DN.1 It has recently been shown that both high-sensitivity Troponin assays (hsTNT) and N-terminal brain natriuretic peptide (pro-BNP) provide predictive values for both cardiac and peripheral microangiopathy in type 2 diabetes (T2D).2 Previous studies on magnetic resonance neurography (MRN) in DN have come to show that, despite the development of clinical symptoms in DN, nerve damage at the level of the lower limbs predominates at thigh level.3 The aim of this study was to investigate the association of sciatic nerve structural damage in 3 Tesla magnetic resonance neurography with hsTNT and pro-BNP serum levels in T2D patients. Methods
51 patients with T2D (23 without DN, 28 with DN) and 10 control subjects without diabetes underwent T2 weighted and diffusion weighted MRN at 3 Tesla. The sciatic nerve’s fractional anisotropy (FA), which has been established as a marker of structural nerve integrity in previous studies,4 was calculated in an automated approach using the FDA approved software Nordic BRAINEX.5 Results were correlated with clinical, electrophysiological, and serological data. Results
In T2D patients, hsTNT showed a negative correlation with the sciatic nerve’s FA (r=-0.52;p<0.001), with a closer correlation in DN patients (r=-0.66, p<0.001). HsTNT further correlated positively with the Neuropathy Dissability Score (NDS; r=0.39, p=0.005). Negative correlations were found with sural nerve conduction velocities (NCVs; r=-0.65, p<0.001), tibial and peroneal NCVs (r=-0.44, p=0.002 and r=-0.42, p=0.003, respectively), and tibial and peroneal amplitudes (r=-0.53, p<0.001 and r=-0.29, p=0.044, respectively). No such correlations were found for pro-BNP. Discussion
The finding that hsTNT but not proBNP shows negative correlations with both the sciatic nerve's FA and electrophysiological parameters indicates that hsTNT as a marker for cardiac microangiopathy parallels peripheral nerve damage that occurs as a consequence of peripheral microangiopathy which is common in type 2 diabetes. Conclusion
To our knowledge, this study is the first to show that hsTNT is a potential indicator for structural nerve damage in T2D. Our results support the hypothesis that peripheral microangiopathy is a key contributor to diabetic neuropathy in T2D. Acknowledgements
This study was funded by the German Research Council (Deutsche Forschungsgesellschaft, DFG, SFB 1158).References
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