Clinical Value of Iodine-123 Beta-Methyliodophenyl Pentadecanoic Acid (BMIPP) Myocardial Single Photon Emission Computed Tomography for Predicting Cardiac Death Among Patients With Chronic Heart Failure

Abstract

Methods Study PopulationSeventy-six patients (22 women, 54 men; mean age, 65± In the present study, the effectiveness of 123 I--methyliodophenyl pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) for predicting cardiac death of patients with chronic heart failure was evaluated. Abnormalities of fatty acid metabolism are found in patients with chronic heart failure and BMIPP was developed as a tracer for scintigraphic assessment of myocardial fatty acid utilization. The study group comprised 74 patients with chronic heart failure with a left ventricular ejection fraction (LVEF) <45% on left ventriculography or radionuclide angiocardiography. They underwent both 201 Tl SPECT and BMIPP SPECT. The uptake of tracer was scored semiquantitatively from 0 (normal) to 4 (defect) in 20 segments and a total defect score (TDS) for all 20 segments was calculated. On planar images the mediastinum to heart count ratio (H/M) was calculated for the BMIPP and Tl studies, and the H/MBMIPP:H/MTl (H/MBMIPP divided by H/MTl) was also calculated. The mean follow-up period was 660 days and there were 17 cases of cardiac death. Multivariate analysis identified H/MBMIPP:H/MTl (p<0.05) and LVEF (p<0.05) as independent predictors of cardiac death. The receiver-operating characteristic curve of H/MBMIPP:H/MTl was situated to the left relative to LVEF. Analysis of the myocardial metabolism by BMIPP SPECT can predict the high-risk patients with chronic heart failure. (Circ J 2003; 67: 918 -924)

Prediction of cardiac events in patients with dilated cardiomyopathy using 123I-BMIPP and 201Tl myocardial scintigraphy

“…Additionally, Narita et al [8] reported that the uptake ratio, which is an indicator of BMIPP uptake by the myocardium, was a signifi cant cardiac event predictor in DCM, and pointed out the importance of monitoring the defect index by serial BMIPP SPECT. Sasaki et al [15] Mismatch between myocardial fatty acid metabolism and perfusion images As a result of comparing BMIPP with Tl, the event-free group did not show any mismatch in many cases, whereas the event group demonstrated a higher percentage of cases with mismatches. However, in univariate analysis, a mismatch has not yet been considered as a signifi cant predictor for cardiac events.…”

123I-BMIPP delayed scintigraphic imaging in patients with chronic heart failure

“…Cardiac imaging with the β-methyl-branched fatty acid analog iodine-123-15-(p-iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) can detect abnormal myocardial fatty acid metabolism in patients with chronic heart failure (CHF) [1,2]. The abnormal uptake of cardiac BMIPP is a sensitive marker of severe myocardial damage in patients with ischemic heart diseases [3][4][5], idiopathic dilated cardiomyopathy (DCM) [6][7][8], hypertrophic cardiomyopathy [9,10], and cardiac sarcoidosis [11].…”

“…The abnormal uptake of cardiac BMIPP is a sensitive marker of severe myocardial damage in patients with ischemic heart diseases [3][4][5], idiopathic dilated cardiomyopathy (DCM) [6][7][8], hypertrophic cardiomyopathy [9,10], and cardiac sarcoidosis [11]. Furthermore, myocardial fatty acid metabolic analysis with BMIPP imaging is an accepted prophylactic tool in strategies to prevent CHF [2,12].…”

Association of Iodine-123 BMIPP and MIBG Cardiac Uptakes with Left Ventricular Functional Parameters Assessed by Gated Myocardial Perfusion SPECT

“…Sasaki et al showed that the H/M of 123 I-BMIPP can predict cardiac death in HF patients in a 660-day follow-up period [5]. Previously, we also reported earlier HF progression for patients with lower H/M of 123 I-BMIPP [4].…”

“…Assessment of cardiac 123 I-BMIPP uptake was reported to be useful for predicting cardiac death in patients with chronic HF [5]. Thus, myocardial 123 I-BMIPP uptake provides not only the estimation of cardiac dysfunction but also prognostic information for cardiac events in patients with heart disease [4][5][6].…”