Underrecognized Utility of ¹²³I-BMIPP in CAD Diagnosis Outside of Japan

¹²³I-BMIPP (Iodine-123 labeled beta-methyl-p-iodophenyl-pentadecanoic acid) is a radiotracer that facilitates non-invasive assessment of myocardial fatty acid metabolism through single photon emission computed tomography imaging. Given that fatty acids serve as one of the primary energy sources for cardiac muscle, reduced uptake of ¹²³I-BMIPP offers valuable insights into the pathophysiology of various cardiac conditions, particularly in coronary artery disease (CAD). Despite its reported efficacy, the use of ¹²³I-BMIPP remains limited outside Japan, primarily due to regulatory and supply challenges. However, in Japan, ¹²³I-BMIPP is clinically utilized for CAD patients with various ischemic conditions as the protocol does not require stress tests or contrast iodine and has a relatively short acquisition time. This review highlights the clinical applications of ¹²³I-BMIPP across various conditions and aims to promote its broader adoption in clinical practice, both in Japan and internationally.