[Experience with mild exercise 123I-BMIPP myocardial imaging in two cases of ischemic heart disease]

During mild to moderate ischemia, glycolytic flux is enhanced and free fatty acid uptake is reduced in proportion to the reduction in mitochondrial metabolism. We considered that mild exercise may induce the reduction of 123I-BMIPP, reflecting myocardial fatty acid metabolism, in ischemic myocardium compared to normal myocardium. Therefore, mild exercise 123I-BMIPP myocardial imaging was carried out to detect myocardial ischemia in 2 cases of ischemic heart disease. Mild exercise was performed using a bicycle ergometer with 25-50 W loading. At seven minutes before cessation of exercise, 111 MBq of 123I-BMIPP was injected. Case 1 was a 12 year-old boy with Kawasaki's disease. The study showed a reduction of mild exercise 123I-BMIPP uptake in the anteroseptal wall. In contrast, stress 201T1 myocardial imaging did not show perfusion defect in the anteroseptal wall. Case 2 was a 64 year-old female with triple vessels disease. Mild exercise 123I-BMIPP myocardial imaging showed similar with those of stress 99mTc-sestamibi. We conclude that mild exercise 123I-BMIPP myocardial SPECT may be a sensitive method to detect myocardial ischemia.