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Simultaneous Assessment of Myocardial Free Fatty Acid Utilization and Left Ventricular Function Using ¹²³I-BMIPP-Gated SPECT

Department of Nuclear Medicine and Diagnostic Imaging, and Department of Cardiovascular Surgery, Kyoto University Faculty of Medicine, Kyoto
Department of Nuclear Medicine, Hokkaido University, Sapporo, Japan

Correspondence: For correspondence or reprints contact: Masayuki Inubushi, MD, Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Faculty of Medicine, 54 Shogoin-Kawahara Sakyo, Kyoto 606-8507, Japan.

ABSTRACT

This study was designed to evaluate the methodological feasibility of ¹²³I-labeled ß-methyl-p-iodophenyl-pentadecanoic acid (BMIPP)-gated SPECT to assess regional and global left ventricular (LV) function in comparison with ^99mTc-sestamibi (methoxyisobutyl isonitrile [MIBI])-gated SPECT and first-pass radionuclide angiography (FPRNA). Methods: Forty-four patients with stable coronary artery disease underwent rest BMIPP-gated SPECT (111 Mbq, 60 s/step) and rest MIBI-gated SPECT (600 MBq, 40 s/step) within a week. From both gated SPECT studies, regional defect scores (DS), wall motion scores (WMS) and wall-thickening scores (WTS) were evaluated visually using 4-point scales for nine segments, and LV ejection fraction (EF) (%) was automatically calculated using Quantitative Gated SPECT (QGS) software. FPRNA was also performed on injection of MIBI. Results: Exact agreement between the two gated SPECT studies was 84.1% ( = 0.706, r = 0.907, P < 0.0001) in WMS and 87.1% ( = 0.662, r = 0.884, P < 0.0001) in WTS. LVEF obtained from BMIPP-gated SPECT linearly correlated with those from MIBI-gated SPECT (y = –0.27 + 0.944x, r = 0.948, SEE = 5.00, P < 0.0001) and FPRNA (y = –7.32 + 1.042x, r = 0.919, SEE = 6.19, P < 0.0001). Even in 21 patients with mismatch segments (BMIPP DS > MIBI DS), agreement was considered to be acceptable in WMS (81.5%, = 0.707, r = 0.853, P < 0.0001) and in WTS (76.7%, = 0.526, r = 0.754, P < 0.0001), and correlation in LVEF remained good between BMIPP-gated SPECT and MIBI-gated SPECT (y = –1.24 + 0.955x, r = 0.938, SEE = 6.25, P < 0.0001) or FPRNA (y = –6.03 + 1.024x, r = 0.913, SEE = 7.38, P < 0.0001). Conclusion: BMIPP-gated SPECT can evaluate regional and global LV function with the QGS software. Therefore, BMIPP-gated SPECT offers the opportunity for simultaneous assessment of myocardial free fatty acid utilization and LV function.

Key Words: gated SPECT • ¹²³I-ß-methyl-p-iodophenyl-pentadecanoic acid • ^99mTc-sestamibi • first-pass radionuclide angiography • left ventricular function

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