The significance of 123I-BMIPP delayed scintigraphic imaging in cardiac patients

Earlier studies have not fully investigated the significance of radionuclide planar imaging in cardiac patients using the fatty acid analogue 123I-beta-methyl-iodophenylpentadecanoic acid ( 123I-BMIPP). This study was to clarify the effectiveness of 123I-BMIPP in assessing the heart-to-mediastinum ratio (H/M) and myocardial washout rate (WR) in patients with heart disease. Myocardial 123I-BMIPP imaging was performed in 33 patients (20 with chronic heart failure [CHF] and 13 with stable angina pectoris [AP]) and 11 control subjects. Myocardial 123I-BMIPP planner images were obtained 30 min (early image) and 4 h (delayed image) after tracer injection. The left ventricular ejection fraction (LVEF) was measured by quantitative gated single photon emission computed tomography. The concentration of plasma brain natriuretic peptide (BNP) was measured before the scintigraphic study. (1) Delayed H/M was much lower in CHF than in AP (1.93 +/− 0.37 vs. 2.21 +/− 0.38, p < 0.05) and controls (vs. 2.47 +/− 0.38, p < 0.001). (2) The WR in CHF and AP were higher than the WR in controls (39.8 +/− 12.7% and 38.7 +/− 11.1 vs. 27.9 +/− 10.2%, p < 0.01 and p < 0.05, respectively). (3) In all subjects, LVEF was correlated with delayed H/M ( r = 0.39, p < 0.01). And, the BNP was correlated with both the WR ( r = 0.36, p < 0.05) and delayed H/M ( r = − 0.29, p = 0.05). These data strongly suggest that the delayed H/M and myocardial WR of 123I-BMIPP enhances the assessment of the myocardial fatty acid metabolism disorders in patients with heart disease in both masked and unmasked conditions.