Related Experiment Videos
[Evaluation of myocardial damage using 123I-BMIPP imaging in patients with vasospastic angina]
Insights
123I-BMIPP myocardial imaging effectively detects left ventricular dysfunction after coronary artery spasm. This SPECT tracer shows higher accuracy than 201Tl in diagnosing vasospastic angina and assessing myocardial impairment.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary artery spasm can lead to left ventricular dysfunction.
- Accurate diagnosis of vasospastic angina (VSA) is crucial for effective management.
- Assessing myocardial metabolic changes is key to understanding VSA pathophysiology.
Observation:
- 20 VSA patients underwent imaging with 123I-BMIPP and 201Tl SPECT.
- 123I-BMIPP showed decreased uptake in 60% of patients and 49% of segments compared to 201Tl.
- Resting 123I-BMIPP imaging revealed greater extent and severity scores than delayed 201Tl imaging.
Findings:
- 123I-BMIPP SPECT demonstrated a significantly higher concordance (75%) with coronary artery spasm than 201Tl SPECT (28%).
- Decreased 123I-BMIPP uptake correlated more strongly with reduced left ventricular wall motion.
- Metabolic abnormalities detected by 123I-BMIPP aligned well with left ventricular asynergy and spastic regions.
Implications:
- 123I-BMIPP SPECT is a sensitive tool for delineating myocardium affected by coronary artery spasm.
- This technique aids in the diagnosis and severity assessment of vasospastic angina.
- It offers valuable insights into the metabolic consequences of coronary artery spasm on cardiac function.
Abstract:
The purpose of this study is to determine whether left ventricular dysfunction following coronary artery spasm by 123I-BMIPP myocardial imaging. To reveal the clinical efficacy of 123I-BMIPP SPECT, 20 patients with vasospastic angina were studied using resting, 3-hour delayed image with 123I-BMIPP and exercise, 3-hour delayed image with 201Tl SPECT. 123I-BMIPP uptake was decreased compared to 201Tl (discordant) in 12 patients (60%) and in 49/100 myocardial segments (49%). The extent and severity score in resting image with 123I-BMIPP were significantly larger than that in delayed image with 201Tl (p < 0.01). In 123I-BMIPP SPECT, the severity score in the latest ischemia were significantly larger than that in others. The incidence of a complete agreement of decreased 123I-BMIPP uptake and coronary artery spasm was significantly higher (75%) than that in 201Tl (28%, p < 0.01). Furthermore, compared to 201Tl uptake, decreased 123I-BMIPP uptake much more corresponded to reduced wall motion in 9 of patients with mismatching. The severity of regional wall motion abnormality was significantly correlated with severity score of 123I-BMIPP. Late redistribution in delayed image with 123I-BMIPP was seen in 6 patients. The regional washout rate and the severity of regional wall motion abnormality in 6 patients was significantly lower than that in others (p < 0.05). Thus, metabolic abnormality assessed by 123I-BMIPP is well associated with left ventricular asynergy and spastic region in patients with vasospastic angina. In conclusion, 123I-BMIPP SPECT may sensitively delineate the impaired myocardium following coronary artery spasm, and it is very useful in diagnosing and estimating the severity of vasospastic angina.