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Abnormal BMIPP Uptake in Chronically Dysfunctional Myocardial Segments: Correlation with Contractile Response to Low-Dose Dobutamine

Departments of Nuclear Medicine and Cardiologology, Middelheim Hospital, Antwerp; Department of Nuclear Medicine, Free University of Brussels, Brussels, Belgium

Correspondence: For correspondence or reprints contact: Anne-Sophie E. Hambÿe, MD, Department of Nuclear Medicine, Middelheim Hospital, Lindendreef 1, 2020 Antwerp, Belgium.

ABSTRACT

Discordance between ¹²³I-15-(p-iodophenyl)-3-(R,S)-methyl penta-decanoic acid (BMIPP) and sestamibi uptake has been described as a good predictor of functional recovery in patients with a recent myocardial infarction. The current investigation aimed at evaluating BMIPP as a viability tracer in patients with chronic ischemie left ventricular dysfunction. Methods: Thirty-one studies were obtained in 25 patients with severe left ventricular dysfunction postinfarction (median infarction age 3.6 mo; range 2 wk–15 yr). All patients underwent dobutamine stress echocardiography and a resting ^99mTc-sestamibi¹²³I-BMIPP SPECT study in a 3-day interval. The relative uptake of the two tracers was compared to the evolution of wall motion during dobutamine infusion in 8 matched myocardial segments. Results: Among the 130 segments with abnormal wall motion at rest, 70 improved under dobutamine. Using sestamibi, a normal uptake was 88% predictive of a positive response to dobutamine, and a decreased uptake of 63% predicted negative stress echocardiography response. In the segments with abnormal sestamibi uptake, adding BMIPP significantly increased the accuracy of scintigraphy to detect residual viability; 28 of 48 segments (58%) with a mismatched pattern demonstrating residual inotropic reserve under dobutamine infusion versus only 5 of 40 segments (13%) with a matched defect. Global agreement between the two approaches was 77%, and positive and negative predictive values for scintigraphy were 72% and 88%, respectively. Conclusion: In patients with chronic ischemie left ventricular dysfunction, the combined assessment of metabolism and perfusion with ¹²³I-BMIPP and ^99mTc-sestamibi correlates well with the response of wall motion to dobutamine during stress echocardiography and is more sensitive than sestamibi alone for differentiating viable from scar segments.

Key Words: iodine-123-15-(p-iodophenyl)-3-(R,S)-methyl pentade-canoic acid • old myocardial infarction • technetium-99m-sestamibi • myocardial viability • dobutamine-stress echocardiography