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Influence of Blood Substrate Levels on Myocardial Kinetics of Iodine-123-BMIPP

Departments of Medicine III and Radiology, Hamamatsu University School of Medicine, Hamamatsu; Department of Internal Medicine, Hamamatsu Red Cross Hospital, Hamamatsu; Ako Research Institute, Otsuka Pharmaceutical Co., Ltd., Ako; First Department of Internal Medicine, Nagoya University, Nagoya, Japan

Correspondence: For correspondence or reprints contact: Chinori Kurata, MD, Department of Medicine III, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu 431-31, Japan.

ABSTRACT

To evaluate the influence of blood substrate levels on myocardial uptake of ¹²³I-labeled beta-methyl-iodophenyl-pentadecanoic acid (BMIPP),we examined the correlation between myocardial BMIPP uptake and blood levels of free fatty acid (FFA), glucose, insulin, triglyceride and total cholesterol. Methods: In 180 patients, venous blood samples were obtained, and the early and late myocardial uptakes (MU15 and MU150) were determined on planar images at 15 and 150 min after injection at rest, respectively, and the clearance rate of BMIPP from the myocardium was calculated. Dynamic SPECT with BMIPP, PET with [¹⁸F]fluoro-deoxyglucose and determination of myocardial carnitine contents were performed in 15, 1 and 3 patients, respectively. Results: In the 180 patients, MU15 correlated with blood insulin (r = 0.22, p = 0.005) and FFA (r = –0.19, p = 0.02) levels, whereas MU150 did not correlate with blood levels of any variables that were measured (p >0.05). The clearance rate correlated with blood insulin (r = 0.28, p <0.001), glucose (r = 0.17, p = 0.03) and FFA (r = –0.40; p <0.001) levels. The correlations were, however, weak, and five patients (2.8%) with no myocardial BMIPP uptake, all of whom had anterior myocardial infarction, had no characteristics regarding the blood substrate levels. Although dynamic SPECT demonstrated rapid myocardial extraction of BMIPP in 13 patients with myocardial BMIPP uptake, it demonstrated no myocardial BMIPP extraction in two patients with no myocardial BMIPP uptake. One of the five patients with no myocardial BMIPP uptake showed increased myocardial [¹⁸F]fluoro-deoxyglucose uptake and decreased myocardial carnitine content. Conclusion: The influence of blood substrate levels on myocardial BMIPP uptake is not very significant, although high serum FFA levels may be associated with slow clearance of BMIPP from the myocardium. The complete absence of myocardial BMIPP uptake is not rare and may not be associated with changes in blood substrate levels or early back diffusion of BMIPP.

Key Words: fatty acid metabolism • Iodine-123-BMIPP • myocardium

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