Differentiation of regional perfusion and fatty acid uptake in zones of myocardial injury

Saito, Tomiyoshi; Yasuda, Tsunehiro; Hk, Gold; Leinbach, Robert C.; Livni, Elijahu; Elmaleh, David; Callahan, Ronald J.; Barlai-Kovach, M; Wilkinson, Robert W.; Aj, Fischman

doi:10.1097/00006231-199108000-00002

Cited by 19 publications

(9 citation statements)

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“…Tamaki et al have shown that areas in which BMIPP was more decreased than 2°1T1 occur more frequently after recent, as opposed to old, myocardial infarction, and in areas supplied by revascularised arteries [1]. Relative excess of fatty acid accumulation as compared to 2°JT1 accumulation did not occur in this study, but has been described by other authors using the same tracers [2]. Our group recently observed that technetium-99m Sestamibi frequently was taken up more than o-phenyl pentadecanoic acid (oPPA), another fatty acid analogue, in areas that were recovering function after thrombolysis [3].…”

Section: Introductionsupporting

confidence: 77%

See 1 more Smart Citation

Relationship between blood flow and fatty acid metabolism in subacute myocardial infarction: a study by means of 99mTc-Sestamibi and 23I-β-methyl-iodo-phenyl pentadecanoic acid

et al. 1994

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Contradictory data have been published on the relative behaviour of fatty acids and flow tracers during the subacute stage of myocardial infarction. Therefore, the present study was set up (1) to investigate the potential occurrence of mismatches between 13-methyl-iodophenyl pentadecanoic acid (BMIPP), a fatty acid analogue, and Sestamibi, and to describe their nature, and (2) to relate these mismatches to clinical characteristics such as whether or not thrombolysis or percutaneous transluminal coronary angioplasty (PTCA) had been performed. Twenty-six patients were studied within 2 weeks after myocardial infarction. Sestamibi and BMIPP single-photon emission tomography (SPET) were performed within 4 days of one another. Activity of both tracers was scored in 16 basal, 16 midventricular and 8 apical segments, using a four-point grading system: 3 = normal (>65% of maximum activity), 2 = mildly decreased (45%-64%), 1 = moderately decreased (25%-44%), 0 = severely decreased (0%-24%). Coronary arteriography was obtained during the same hospital stay. Four hundred and seventy-seven segments out of 1040 studied were abnormal for at least one tracer: 197 with higher Sestamibi activity (group I), 226 with equal scores for Sestamibi and BMIPP (group II) and 54 with higher BMIPP activity (group III). Seventy-five percent of group I segments and 84% of group III segments were found in infarct-related artery territories. Group I segments were associated with acute thrombolysis and/or PTCA (P < 0.01), and with the absence of prior infarction in the territory of the infarct-related artery (P < 0.001). Group III segments were associated with the absence of thrombolysis or PTCA (P < 0.001), with occlusion of the infarct-related artery (P < 0.001), with previous infarction in the same territory (P < 0.001) and with a-or dyskinesia in this territory (P < 0.001). These data could support the interpretation that areas in which the uptake Correspondence to: F. De Geeter, Academisch Ziekenhuis VUB, Dienst Nucleaire Geneeskunde, Laarbeeklaan 101, B-1090 Brussels, Belgium of BMIPP is more decreased than that of Sestamibi (group I) are due to delayed recovery of fatty acid metabolism after reperfusion, whereas those with higher BMIPP than Sestamibi activity (group III) are accounted for by the enhanced metabolism induced by passive systolic wall stretch.

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Section: Introductionsupporting

confidence: 77%

“…The present study in patients with myocardial infarction was thus set up (1) to investigate the presence of mismatches between BMIPP and Sestamibi and to describe their nature and (2) to explore the influence of thrombolysis and revascularisation on their occurrence.…”

Section: Introductionmentioning

confidence: 99%

Relationship between blood flow and fatty acid metabolism in subacute myocardial infarction: a study by means of 99mTc-Sestamibi and 23I-β-methyl-iodo-phenyl pentadecanoic acid

et al. 1994

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“…In a preliminary clinical study, Saito et al [11] showed greater uptake of methylated fatty acid than of 201T1 in patients with ischemia, due to an increase in size of the triglyceride pool in ischemic tissue. Prolonged per fusion, however, may decrease net extraction of the BMIPP fraction, particularly in patients with myocardial infarctions.…”

Section: Diabetes With Chdmentioning

confidence: 98%

Myocardial Uptake of an lodinated Branched Fatty Acid Analog, Assessed by SPECT, May Detect Metabolic Derangement of the Myocardium in Diabetic Patients with Coronary Heart Disease

Kanda

Suzuki²,

Toyama³

et al. 1995

Cardiology

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The clinical implications of single-photon emission computed tomography using both a beta-methyl-branched fatty acid analog, ¹²³I-15-(ρ-idophenyl)-3-methyl-pentadecanoic acid (BMIPP), and thallium-201 (²⁰¹Tl) were assessed in 30 patients with myocardial infarction (MI), 8 diabetics, 4 patients with impaired glucose tolerance, and 18 nondiabetic patients. Discordant decreases in BMIPP uptake, as compared with ²⁰¹Tl uptake, in diabetic patients were significantly (p < 0.01) more frequent than in nondiabetic patients. The left ventricular (LV) ejection fraction in diabetics was significantly (p < 0.05) reduced and the LV diastolic dimension was significantly increased (p < 0.01), as compared with those in nondiabetic subjects. Analysis of peripheral blood showed no significant differences among the three test groups in metabolic abnormality. A discordant decrease in BMIPP uptake, as compared with Tl uptake, in cardiac tomography may indicate a metabolic derangement of the myocardium in diabetic patients with MI.

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“…Each patient was instructed to fast overnight on the day of the BMIPP study. Data acquisition was started 20 min after radionuclide injection using a three-headed SPET system (GCA9300A/HG, Toshiba, Tokyo) equipped with low-energy high-resolution parallel-hole collimators which cover up to 169 keV with less than 5% septal penetration and a dedicated nuclear medicine computer (GMS 550U, Toshiba Tokyo) [26]. The energy discrimination was centered on 159 keV with a 20% window.…”

Section: Bmipp Spetmentioning

confidence: 99%

“…It is suitable for single-photon emission tomography (SPET) since its prolonged myocardial retention is appropriate for the longer data acquisition periods required for tomographic imaging. Use of BMIPP has been investigated in animal models and patients with hypertensive heart disease [19,20], cardiomyopathy [21][22][23][24] and ischaemic heart disease [25][26][27][28][29][30], and the uncoupling of the regional uptake of thallium-201 or technetium-99m sestamibi and labelled modified fatty acids has been reported. A recent study reported that decreased resting BMIPP uptake compared with resting ;0~T1 or 99mTc-sestamibi was frequently observed in patients with myocardial infarction, and especially in those with acute myocardial infarction [27][28][29], However, in patients with chronic coronary artery disease with and without old myocardial infarction, the frequency of discordant fatty acid uptake less than 2°1Tl uptake and its relation to wall motion and the presence of ischaemia remain to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Impairment of regional fatty acid uptake in relation to wall motion and thallium-201 uptake in ischaemic but viable myocardium: Assessment with iodine-123-labelled beta-methyl-branched fatty acid

et al. 1995

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In coronary artery disease, discrepancy in the uptake of thallium-201 and of methyl-branched fatty acid at rest has been described. The purpose of this study was to evaluate iodine-123 labelled beta-methyl-branched fatty acid (BMIPP) myocardial uptake and wall motion at rest in segments with stress-induced ischaemia identified by stress 201Tl tomography in patients with chronic coronary artery disease. 123I-BMIPP myocardial tomography was performed at rest and was compared with the findings of exercise-reinjection 201Tl tomography in 45 patients with chronic coronary artery disease. Regional wall motion was evaluated by contrast left ventriculography in 36 patients. Among 237 segments with reversible 201Tl defects, equally decreased uptake on both reinjection 201Tl and BMIPP images was observed in 93 (39%), more severely decreased uptake of BMIPP in 118 (50%) and more severely decreased uptake of reinjection 201Tl in 26 (11%). On the other hand, among 90 segments with non-reversible 201Tl defects, each pattern was observed in 71 (79%), 6 (7%) and 13 (14%) segments, respectively. When comparing the ischaemic segments with and without more severely reduced uptake of BMIPP than of reinjection 201Tl, wall motion was impaired to a greater extent in the segments with more severely reduced uptake of BMIPP than of reinjection 201Tl [severe hypo- or dyskinesis was present in 64 (70%) of 91 segments and in 24 (22%) of 110 segments, respectively, P<0.005]. In patients with chronic coronary artery disease, resting fatty acid uptake was frequently more reduced than reinjection 201Tl in the segments with stress-induced ischaemia, while in most of the fixed perfusion defects BMIPP and reinjection 201Tl uptake decreased concordantly. In ischaemic myocardium, wall motion was impaired to a greater extent in those segments which showed more severely reduced uptake of BMIPP than of reinjection 201Tl. In ischaemic but viable myocardium, discordant BMIPP uptake less than reinjection 201Tl uptake may indicate metabolic alterations and wall motion abnormality at rest independent of perfusion abnormalities. In conclusion, the combination of resting BMIPP and stress-reinjection 201Tl imaging may provide information on metabolic alterations and wall motion abnormality at rest independent of perfusion abnormalities.

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Differentiation of regional perfusion and fatty acid uptake in zones of myocardial injury

Cited by 19 publications

References 0 publications

Relationship between blood flow and fatty acid metabolism in subacute myocardial infarction: a study by means of 99mTc-Sestamibi and 23I-β-methyl-iodo-phenyl pentadecanoic acid

Relationship between blood flow and fatty acid metabolism in subacute myocardial infarction: a study by means of 99mTc-Sestamibi and 23I-β-methyl-iodo-phenyl pentadecanoic acid

Myocardial Uptake of an lodinated Branched Fatty Acid Analog, Assessed by SPECT, May Detect Metabolic Derangement of the Myocardium in Diabetic Patients with Coronary Heart Disease

Impairment of regional fatty acid uptake in relation to wall motion and thallium-201 uptake in ischaemic but viable myocardium: Assessment with iodine-123-labelled beta-methyl-branched fatty acid

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