Elsevier

Journal of Nuclear Cardiology

Volume 12, Issue 2, March–April 2005, Pages 172-178
Journal of Nuclear Cardiology

Original articles
Prognostic value of I-123 15-(p-iodophenyl)-3-(R,S) methylpentadecanoic acid myocardial imaging in patients with known or suspected coronary artery disease

https://doi.org/10.1016/j.nuclcard.2004.12.293Get rights and content

Background

Although iodine 123 15-(p-iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) can assess abnormal utilization of fatty acid in the diseased myocardium, the prognostic value of BMIPP imaging at rest in patients with known or suspected coronary artery disease (CAD) remains unclear.

Methods and results

A total of 270 patients were included by a retrospective search of the existing databases of 4 institutions. In addition to hard events, consisting of cardiac death and nonfatal myocardial infarction, any significant events including death, nonfatal myocardial infarction, coronary revascularization, heart failure, and unstable angina were assessed. During a median follow-up of 3.9 years, 33 patients had significant events, among whom 10 had hard events. Kaplan-Meier survival estimates revealed a hard event-free survival rate of 98% at 3 years in patients with a BMIPP defect score lower than 5 but 93% in those with a defect score of 5 or greater (P = .03). With regard to significant events, the analysis showed an event-free survival rate of 92% at 3 years in patients with a BMIPP defect score lower than 5 but 80% in those with a defect score of 5 or greater (P = .0003).

Conclusions

These results indicate that resting BMIPP imaging has prognostic value and may have a role in the risk stratification of patients with known or suspected CAD.

Section snippets

Study group

The study group was identified retrospectively by searching the existing databases of the nuclear cardiology laboratories at 4 institutions: Tokyo Medical University, Tokyo; Kyoto Second Red Cross Hospital, Kyoto; Nagoya Daini Red Cross Hospital, Nagoya; and Nippon Medical School, Tokyo, Japan. Patients who underwent BMIPP SPECT for the evaluation of known or suspected CAD because of clinical symptoms, multiple coronary risk factors, or abnormal electrocardiogram after January 1, 1998, and

Overall results

The mean age of 270 patients who completed follow-up was 62 ± 12 years; there were 122 men and 148 women. In the outpatient clinic, SPECT studies were performed in 133 patients, as well as in 137 patients during hospital admission. Of these 137 patients, 54 were admitted on an emergency basis and the remaining 83 were admitted as scheduled. The summed defect score of BMIPP was less than 1 in 132 patients and 1 or greater in the remaining 138 patients, with a median value of 5. Medications at

Discussion

This study demonstrates that an iodinated fatty acid analog, BMIPP, can be used for metabolic imaging of the myocardium at rest to identify a group of patients who are at high risk for subsequent cardiac events. The majority patients in the current patient population (approximately 93%) were those with suspected CAD, excluding those with previous MI. Thus abnormal findings on resting BMIPP myocardial imaging, which were predictive of cardiac events such as cardiac death, nonfatal MI, and

Acknowledgment

We are grateful to Dr Shin-ichiro Kumita of Nippon Medical School, Tokyo; Dr Haruo Hirayama of Nagoya Daini Red Cross Hospital, Nagoya; and Drs Akira Yamashina, Satoshi Hida, Takayuki Morishima, Hidefumi Yanagisawa, Yasuhiro Usui, Katsufumi Harafuji, and Yuko Igarashi of Tokyo Medical University, Tokyo, Japan, for their data acquisition and advice in the preparation of the manuscript. In addition, we wish to thank Professor J. Patrick Barron and Assistant Professor Raoul Breugelmans of the

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