Assessment of fatty acid uptake in ischemic heart disease without myocardial infarction

Abstract

To assess the clinical value of 123I fatty acid analog, 123I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) was imaged at rest in coronary patients without prior myocardial infarction. The BMIPP findings were compared with various clinical parameters.

Methods: Thirty-one patients with ischemic heart disease (19 with unstable angina, 12 with stable angina), without myocardial infarction underwent BMIPP SPECT at rest, coronary arteriography, rest/stress thallium SPECT and left ventriculography exams.

Results: Regional decrease of BMIPP was seen in 63% of the myocardial areas at risk, whereas regional perfusion decrease at rest was observed only in 35% (p < 0.01). The BMIPP decrease was more often seen in the unstable group (79%) than stable group (38%) (p < 0.01). Stress-induced ischemia was seen in 77% of segments with decreased BMIPP uptake in unstable group and in 57% in the stable group. Frequency and severity of BMIPP abnormality increased with the severity of stress-induced ischemia (p < 0.005) and the severity of coronary artery stenosis (p < 0.005). In addition, regional BMIPP abnormality was related to severity of wall motion abnormalities (p < 0.005). While 67% of segments with a wall motion abnormality showed BMIPP decrease, 36% with normal wall motion also showed BMIPP decrease (p < 0.01).

Conclusion: Abnormal fatty acid metabolism was often observed at rest in patients with ischemic heart disease without history of myocardial infarction, and the abnormalities were related to severe myocardial ischemia and regional wall motion abnormalities.