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Evaluation of Left Ventricular Function Using Electrocardiographically Gated Myocardial SPECT with ¹²³I-Labeled Fatty Acid Analog

Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya; and First Department of Internal Medicine and Department of Clinical Laboratory Medicine, Nagoya University School of Medicine, Nagoya, Japan

Electrocardiographically (ECG) gated myocardial SPECT with ^99mTc-tetrofosmin has been used widely to assess left ventricular (LV) function. However, the accuracy of variables using ECG gated myocardial SPECT with ß-methyl-p-¹²³I-iodophenylpentadecanoic acid (BMIPP) has not been well defined. Methods: Thirty-six patients (29 men, 7 women; mean age, 61.6 ± 15.6 y) with ischemic heart disease underwent ECG gated myocardial SPECT with ¹²³I-BMIPP and with ^99mTc-tetrofosmin and left ventriculography (LVG) within 1 wk. LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV) were determined on gated SPECT using commercially available software for automatic data analysis. These volume-related items on LVG were calculated with an area–length method and were estimated by 2 independent observers to evaluate interobserver validity. The regional wall motion with these methods was assessed visually. Results: LVEF was 41.1% ± 12.5% on gated SPECT with ¹²³I-BMIPP, 44.5% ± 13.1% on gated SPECT with ^99mTc-tetrofosmin, and 46.0% ± 12.7% on LVG. Global LV function and regional wall motion between both gated SPECT procedures had excellent correlation (LVEF, r = 0.943; LVEDV, r = 0.934; LVESV, r = 0.952; regional wall motion, = 0.92). However, the correlations of global LV function and regional wall motion between each gated SPECT and LVG were significantly lower. Gated SPECT with ¹²³I-BMIPP showed the same interobserver validity as gated SPECT with ^99mTc-tetrofosmin. Conclusion: Gated SPECT with ¹²³I-BMIPP provides high accuracy with regard to LV function and is sufficiently applicable for use in clinical SPECT. This technique can simultaneously reveal myocardial fatty acid metabolism and LV function, which may be useful to evaluate various cardiac diseases.

Key Words: gated SPECT • ß-methyl-p-¹²³I-iodophenylpentadecanoic acid • ^99mTc-tetrofosmin • left ventriculography • left ventricular function