Decreased uptake of iodinated branched fatty acid analog indicates metabolic alterations in ischemic myocardium

Abstract

We previously reported that uptake of 123I-labeled 15-iodophenyl 3-methyl pentadecanoic acid (BMIPP) was lower than that of thallium in ischemic myocardium. Such discordant findings between BMIPP and thallium were compared with those of PET using 18F-deoxyglucose (FDG) and 11C-acetate to assess metabolic alterations in such segment.

Methods: Sixteen patients with coronary artery disease underwent both BMIPP SPECT and PET. Relative FDG uptake (% FDG uptake) and the clearance rate constant (% Kmono) of 11C-acetate from the myocardium were calculated as markers of glucose and oxidative metabolism, respectively.

Results: Relative FDG uptake of the myocardial segments with reduced BMIPP uptake and normal thallium uptake (discordant segments) was similar (85.3 +/- 10.3) to that of the normal segments (86.5 +/- 11.7) but higher than that of segments with reduced uptake of both BMIPP and thallium (67.5 +/- 19.9). Similarly, the discordant segments showed a higher % Kmono value (77.8 +/- 13.1 versus 70.0 +/- 19.1) and FDG-to-perfusion ratio (1.15 +/- 0.08 versus 1.01 +/- 0.22) than in the concordantly reduced segments.

Conclusion: BMIPP uptake appears to provide metabolic information independent of thallium uptake. Combined imaging of BMIPP and thallium may potentially identify ischemic but viable myocardium.