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Regional Metabolic Abnormality in Relation to Perfusion and Wall Motion in Patients with Myocardial Infarction: Assessment with Emission Tomography Using an Iodinated Branched Fatty Acid Analog

Department of Nuclear Medicine and Third Division, Department of Internal Medicine, Kyoto University Faculty of Medicine, Kyoto
Kobe General Hospital, Kobe, Japan

Correspondence: For reprints contact: Nagara Tamaki, MD, Department of Nuclear Medicine, Kyoto University Faculty of Medicine, Shogoin, Sakyo-ku, Kyoto, 606 Japan.

ABSTRACT

The clinical usefulness of single-photon tomography using both a beta-methyl-branched fatty acid analog, ¹²³I-15-(piodophenyl)-3-methyl pentadecanoic acid (BMIPP) and ²⁰¹Tl was assessed in 4 normal subjects and 28 patients with myocardial infarction. A homogeneous distribution of the tracer in the left ventricular myocardium was observed in each normal subject. BMIPP uptake was decreased compared to ²⁰¹Tl (discordant) in 17/28 patients (61%) and in 49/196 myocardial segments (25%). Such discordant BMIPP uptake was observed more often in areas of acute myocardial infarction (59%at 4 wk versus 31% at >4 wk after onset)(p < 0.01) and areas supplied with revascularized arteries (74% for revascularized versus 28% for nonrevascularized areas) (p < 0.01). In addition, the discordant BMIPP uptake was seen more often in the segments exhibiting a wall motion score lower than the perfusion score (46%) in comparison to segments showing a similar decrease in both the wall motion and perfusion scores (12%)(p< 0.01). Thus, BMIPP imaging may play a major role in increasing our understanding of the relationship between perfusion and wall motion, particularly in patients with acute myocardial infarction and those who received revascularization therapy.

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