Prognostic Value of ¹²³I-BMIPP SPECT in Patients with Nonischemic Heart Failure with Preserved Ejection Fraction

Abstract

Imaging of myocardial fatty acid metabolism using I-betamethyl--iodophenyl-pentadecanoic acid (I-BMIPP) SPECT is useful for identifying high-risk patients with known ischemic heart disease. However, its utility for patients who have nonischemic heart failure with preserved ejection fraction is not well known. This study aimed to evaluate the prognostic value of the I-BMIPP defect score in such patients. Of 804 consecutive patients who were admitted to the hospital because of acute heart failure and underwent I-BMIPP SPECT, we identified 133 (mean age ± SD, 73 ± 13 y) who had normal coronary arteries by invasive coronary angiography and preserved left ventricular ejection fraction (≥50%) by echocardiography.I-BMIPP defects were quantitatively scored to obtain summed defect scores in 17 segments of I-BMIPP SPECT images. The patients were divided into 2 groups based on their score. The multivariate Cox model was used to assess a possible correlation between a higher score (≥4, = 46) and major adverse cardiac events, including cardiac death, cardiovascular events, and hospitalization for heart failure, compared with a lower score (<4, = 87). During a mean follow-up of 2.5 y, 35 major adverse cardiac events occurred. The median scores in the high-score and low-score groups were 7.13 ± 4.21 and 1.29 ± 0.80, respectively. By multivariate Cox analysis, a higher score was associated with increased major adverse cardiac events, compared with a lower score (hazard ratio, 11.04; 95% confidence interval, 4.93-24.74; < 0.001). This study demonstrated that the defect score byI-BMIPP SPECT may have potential prognostic value in patients who have nonischemic heart failure with preserved ejection fraction.

Prognostic values of coronary artery calcium score and 123I-BMIPP SPECT in patients with non-ischemic heart failure with preserved ejection fraction

“…More speci cally, endothelial dysfunction initially causes atherosclerosis, leading to the development of hypertension, increase of extracellular matrix material, and brosis within myocardial tissue, which in turn results in left ventricular diastolic dysfunction. The present study demonstrated the potential of CACS to re ect the status of atherosclerosis, similar to a previous study which showed that BDS has the potential for re ecting the amount of extracellular matrix material and brosis within the myocardial tissue [9].…”

“…A Butterworth lter (order 8.0, cutoff value 0.25-0.30 cycle/pixel) and ltered back projection were used to process and reconstruct the images, respectively. BDS was calculated according to a previously reported method [9], using an automated program for myocardial SPECT (Heart Risk View-S software; Nihon Medi-Physics Co Ltd, Tokyo, Japan). A hybrid 2part sampling method [13], i.e., an algorithm for generating a polar map, was used to generate count pro les from a 3-dimensional sampling scheme of short-axis slices by operating in a 3-dimensional space and using short axis images.…”

“…Although, in the clinical setting, the relationship between 123 I-BMIPP defect score (BDS) and CACS of the patients with NIHFpEF, and clinical importance of them were unclear. Our previous study showed that 123 I-BMIPP SPECT could be a useful modality for identifying high-risk patients with NIHFpEF [9]. In the present study, we aimed to investigate whether CACS is associated with the occurrence of major cardiac events (MACEs) and to compare the prognostic value of CACS with that of BDS in patients with NIHFpEF.…”

A prospective randomized study comparing effects of empagliflozin to sitagliptin on cardiac fat accumulation, cardiac function, and cardiac metabolism in patients with early-stage type 2 diabetes: the ASSET study

“…Furthermore, various CVD outcome trials have indicated that DPP-4 inhibitors increase the risk of hospitalizations due to heart failure [9,51]. Unexpectedly, SRS, as assessed by 123 I-BMIPP scintigraphy, which indicates myocardial fatty acid uptake and is associated with LV wall motion abnormality [27] as well as the incidence of CVD events [28,52], showed significantly decreased values from baseline only in the sitagliptin group, although the values were not statistically different between groups. This reduction may be due to the higher baseline values in the sitagliptin group and, thus, may not have clinical implications considering that the patients in the sitagliptin group had no history of CVD events.…”

Systolic aortic regurgitation predicts all-cause mortality and hospitalization in outpatients with heart failure and preserved ejection fraction

“…H eart failure with preserved ejection fraction (HFpEF) is the most frequent form of heart failure (HF) in ambulatory patients, and therefore, early identification of high-risk patients for hospitalization and/or death is crucial [1,2]. Improvements in risk stratification by identification of new risk scores, biomarkers and imaging techniques have been extensively investigated in the past decade [3][4][5]. Several echocardiograhic parameters such as left ventricular hypertrophy, pulmonary hypertension, and various indices of diastolic stiffness have also been associated with worse prognosis in HFpEF [6][7][8].…”