Angiotensin-converting enzyme inhibition improves cardiac fatty acid metabolism in patients with congestive heart failure

Abstract

This study aimed to examine whether angiotensin-converting enzyme (ACE) inhibition improved cardiac fatty acid metabolism in patients with congestive heart failure (CHF). Myocardial 123I-beta-methyl-iodophenylpentadecanoic acid (123I-BMIPP) imaging was performed in 25 patients with CHF and in 10 control subjects. Myocardial 123I-BMIPP images were obtained 30 min and 4 h after tracer injection. The heart-to-mediastinum (H/M) ratio of 123I-BMIPP uptake and the washout rate of 123I-BMIPP from the myocardium were calculated. Patients were given enalapril for 6 months, and 123I-BMIPP imaging was repeated. H/M ratios on early and delayed images were lower in CHF patients than in normal controls (P<0.01). The washout rate of 123I-BMIPP from the myocardium was faster in CHF patients than in controls (P<0.01). As the severity of the New York Heart Association (NYHA) functional class increased, the H/M ratio decreased and the washout rate increased. The washout rate of 123I-BMIPP was inversely correlated with left ventricular fractional shortening (R=-0.62, P<0.01). ACE inhibition with enalapril increased the H/M ratio on delayed images (P<0.05) and reduced the washout rate of 123I-BMIPP (P<0.05) in CHF patients. These data suggest that: (1) angiotensin II-mediated intracellular signalling activation may be a possible mechanism for the decreased myocardial uptake and enhanced washout of 123I-BMIPP in heart failure patients; and (2) the improvement in fatty acid metabolism by ACE inhibition may represent a new mechanism for the beneficial effect of this therapy in heart failure.

Restored Cardiac Conditions and Left Ventricular Function After Parathyroidectomy in a Hemodialysis Patient Parathyroidectomy Improves Cardiac Fatty Acid Metabolism Assessed by 123I-BMIPP

“…9 The washout rate of BMIPP in the present case increased in accordance with the improvement in LV function after PTX, although it has been reported that the washout rate of BMIPP is enhanced in patients with heart failure. 18,24,25 The increase in the washout rate in the present case might correspond to improved transportation of BMIPP-CoA through the mitochondrial membrane affected by PTH, as the level of carnitine did not change after PTX, which also suggests that PTH played an important role in the LV dysfunction in the present case. The washout rate of 123 I-BMIPP might be a useful marker for estimating the effect of PTX on cardiac function.…”

“…The present case showed an increase in the H/M and washout of 123 I-BMIPP in accordance with improvement in congestive heart failure symptoms after PTX. Yamaguchi et al reported that the H/M decreased in patients with congestive heart failure, 18 and fatty acid uptake was reduced in an animal model of pacing-induced heart failure. 19 The increased H/M in the present case might indicate improved fatty acid uptake.…”

Prediction of cardiac events in patients with dilated cardiomyopathy using 123I-BMIPP and 201Tl myocardial scintigraphy

“…Watanabe et al [12] reported a significant correlation between the effi cacy of the improvement in cardiac function induced by ACE-I and BMIPP indicators in chronic heart failure. Furthermore, Yamauchi et al [13] demonstrated a signifi cant improvement in the delayed H/M ratio and washout rate of BMIPP after ACE-I administration, and concluded that BMIPP is useful in evaluating the effi cacy of ACE-I. We previously examined the effi cacy of ES and SS of BMIPP for predicting the improvement in cardiac function as a result of beta-blocker therapy, and reported that ES and SS in patients with improved cardiac function are signifi cantly lower than in patients with no improvement [14].…”

Association of Iodine-123 BMIPP and MIBG Cardiac Uptakes with Left Ventricular Functional Parameters Assessed by Gated Myocardial Perfusion SPECT

“…However, FA oxidation is easily impaired by various pathological factors leading to heart failure (HF). Iodine-123-labeled 15-(p-iodophenyl) -3-(R, S)-methylpentadecanoic acid ( 123 I-BMIPP) is a radioactive FA analog [2], and has been shown to be useful for evaluating the severity in patients with HF [3,4]. Myocardial uptake of 123 I-BMIPP was correlated with the grade of the New York Heart Association functional class [3].…”

“…Iodine-123-labeled 15-(p-iodophenyl) -3-(R, S)-methylpentadecanoic acid ( 123 I-BMIPP) is a radioactive FA analog [2], and has been shown to be useful for evaluating the severity in patients with HF [3,4]. Myocardial uptake of 123 I-BMIPP was correlated with the grade of the New York Heart Association functional class [3]. Assessment of cardiac 123 I-BMIPP uptake was reported to be useful for predicting cardiac death in patients with chronic HF [5].…”