Iodofiltic Acid I 123 (BMIPP) Fatty Acid Imaging Improves Initial Diagnosis in Emergency Department Patients With Suspected Acute Coronary Syndromes

Kontos, Michael C.; Dilsizian, Vasken; Weiland, Frederick L.; DePuey, Gordon; Mahmarian, John J.; Iskandrian, Ami E.; Bateman, Timothy M.; Heller, Gary V.; Ananthasubramaniam, Karthik; Li, Yong; Goldman, Jonathan L.; Armor, Tom; Kacena, Katherine; LaFrance, Norman; Garcia, Ernest; Babich, John W.; Udelson, James E.

doi:10.1016/j.jacc.2010.03.045

Cited by 68 publications

(33 citation statements)

References 29 publications

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“…In an open-label phase IIA clinical trial, the utility of fatty acid metabolism with 123 I-BMIPP to detect myocardial ischemic memory was shown up to 30 h after exercise-induced ischemia (10). In a subsequent phase III clinical trial, the safety and efficacy of 123 I-BMIPP were evaluated in patients presenting to an emergency department with symptoms suggestive of acute coronary syndrome (12). When the 123 I-BMIPP data were added to the initial clinical diagnosis alone, the sensitivity for the acute coronary syndrome diagnosis nearly doubled without sacrificing specificity.…”

Section: Novel Findings and Applications: A Tale Of 3 Radiotracersmentioning

confidence: 99%

Challenging Nuclear Cardiology Research: Stimulating Discovery, Validation, and Clinical Relevance

Dilsizian

2017

J Nucl Med

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Most of what we know of nuclear cardiology has been discovered in the last nearly 50 y. In tracing the history of nuclear cardiology research, we find that, early on, it attracted the attention of some of the best minds in nuclear medicine and cardiology, who were working closely with highly talented, skilled, and academically engaged radiochemists, physicists, and technologists. This successful blueprint of an integrated approach to scientific discovery that addresses clinically relevant issues remains true today and should remain true in the future.Nuclear imaging expands the traditional imaging of anatomic structures to physiologic and biochemical structures or biologic processes. A key attribute of nuclear molecular imaging is that it allows clinicians to visualize cellular functions that influence progression of disease, therapeutic responsiveness, and ultimately patient outcome. Such molecularly targeted imaging has the potential to direct new drug development and new gene-and cellbased therapies and to determine the subset of patients who are most likely to respond to such therapies. Since the introduction of myocardial perfusion (1) and metabolic agents (2), there has been explosive growth in the literature on, and National Institutes of Health funding of, experimental studies on cardiovascular molecular imaging. Unfortunately, such advances in the basic sciences have not translated into clinically approved diagnostic or therapeutic agents. Important challenges that have limited the progression to clinical reality include cost, scalability, and regulatory burden (3). HOW TO INCREASE THE RELEVANCE OF RESEARCHFor a productive pursuit of scientific investigation, it is essential that a lead or idea be clinically relevant and that it address an unmet need. Next, there must be methodologic and imaging procedures capable of visually or quantitatively capturing the specific biologic process of interest, such as metabolic pathway, receptor biology, or enzyme regulation. For example, the ability to image the metabolic shift of energy production from fatty acids to glucose in the setting of reduced myocardial blood flow at rest has helped explain the pathophysiology of viable, hibernating myocardium and critical patient management decisions regarding coronary artery revascularization, left ventricular assist device placement, cardiac transplantation, or continued medical therapy (4,5).In medicine, we must try to infer the nature of the biologic system from measured dynamic function and to derive information about their causes and interrelations in order to understand normal and abnormal disease conditions. Dynamic and quantitative analysis is a key virtue of nuclear radiotracer-based imaging. It allows assessment of changes in enzymatic or receptor activity as a function of disease severity and time. Creation of the time profile of the change in disease process is critical in following progression or regression of disease and the therapeutic effect of medications over a long period, such as days, weeks, or months....

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Section: Novel Findings and Applications: A Tale Of 3 Radiotracersmentioning

confidence: 99%

Challenging Nuclear Cardiology Research: Stimulating Discovery, Validation, and Clinical Relevance

Dilsizian

2017

J Nucl Med

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“…In patients with acute chest pain presenting to the emergency department, a cardiac BMIPP scan within 30 hours of the last episode of chest pain provides incremental value to clinical data in establishing the early diagnosis of acute coronary syndromes. 20 An abnormal BMIPP study also has been shown to have good diagnostic accuracy and prognostic utility in …”

Section: Cardiac Fatty Acid Metabolism Radionuclide Imaging For Myocamentioning

confidence: 99%

Nuclear Cardiology: 2014 Innovations and Developments

Mahmarian

Chang

Nabi

2014

Methodist DeBakey Cardiovascular Journal

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“…Kontos et al [25] conducted a multicenter trial to evaluate the efficacy and safety of BMIPP in patients presenting to the emergency department with symptoms suggestive of ACS. A total of 507 patients with no history of prior infarction were enrolled at 50 centers in the United States and Canada.…”

Section: Recent Developments In Fa Imaging Of Myocardial Ischemiamentioning

confidence: 99%

“…Patients underwent resting BMIPP imaging within 30 h of cessation of symptoms. The efficacy population consisted of the 448 patients who received an adjudicated final diagnosis of ACS (defined as a positive troponin; ST-segment depression on electrocardiography; an angiographically visible culprit lesion; inducible ischemia on myocardial perfusion imaging; and/or coronary revascularization, infarction, or death during a 30-day follow-up period), intermediate likelihood ACS (defined as borderline cardiac troponin levels; a 70% to 89% coronary stenosis in the absence of a culprit lesion; or coronary revascularization in the absence of a positive perfusion imaging study), or negative ACS [25]. The sensitivity of BMIPP imaging alone for the diagnosis of ACS was 73%, compared with a sensitivity of only 43% for a clinical diagnosis.…”

Section: Recent Developments In Fa Imaging Of Myocardial Ischemiamentioning

confidence: 99%

Fatty Acid Imaging of the Heart

Giedd

Bergmann

2011

Curr Cardiol Rep

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Imaging metabolic processes in the human heart yields valuable insights into the mechanisms contributing to myocardial pathology and allows assessment of the efficacy of therapies designed to treat cardiac disease. Recent advances in fatty acid (FA) imaging using positron emission tomography (PET) include the development of a method to assess endogenous triglyceride metabolism and the design of new fluorine-18 labeled tracers. Studies of patients with diabetes have shown that the heart is resistant to insulin-mediated glucose uptake and that metabolism of nonesterified FA is upregulated. Cardiac PET imaging has also recently shown the increase in myocardial FA uptake seen in obese patients can be reversed with weight loss. And a pilot study of patients with chronic kidney disease demonstrated that PET imaging can reveal myocardial metabolic alterations that parallel the decline in estimated glomerular filtration rate. Recent advances in FA imaging using single photon emission computed tomography (SPECT) have been accomplished with the tracer β-methyl-p-[(123)I]-iodophenyl-pentadecanoic acid (BMIPP). Two meta-analyses showed this imaging technique has a diagnostic accuracy for the detection of obstructive coronary artery disease that compares favorably with SPECT myocardial perfusion imaging and that BMIPP imaging yields excellent prognostic data in patients across the spectrum of coronary artery disease. A recent multicenter study of patients presenting with acute coronary syndromes found BMIPP SPECT imaging has greater diagnostic sensitivity than, and enhances the negative predictive value of, clinical assessment alone. Because of their exquisite sensitivity, nuclear imaging techniques facilitate the study of physiologic processes that are the key to our understanding of cardiac metabolism in health and disease.

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Iodofiltic Acid I 123 (BMIPP) Fatty Acid Imaging Improves Initial Diagnosis in Emergency Department Patients With Suspected Acute Coronary Syndromes

Cited by 68 publications

References 29 publications

Challenging Nuclear Cardiology Research: Stimulating Discovery, Validation, and Clinical Relevance

Challenging Nuclear Cardiology Research: Stimulating Discovery, Validation, and Clinical Relevance

Nuclear Cardiology: 2014 Innovations and Developments

Fatty Acid Imaging of the Heart

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