Assessment of improvement of myocardial fatty acid uptake and function after revascularization using iodine-123-BMIPP

We used beta-methyl iodophenyl pentadecanoic acid (BMIPP) to evaluate changes in myocardial fatty acid utilization before and after revascularization and the ability of BMIPP to predict functional recovery in patients with chronic coronary artery disease.

Thirty-four patients with chronic coronary artery disease (60 +/- 10 yr) underwent BMIPP and 201Tl SPECT (stress-reinjection 201Tl in 29 patients and resting 201Tl in 5 patients) before and 2-5 wk after percutaneous transluminal angioplasty (n = 23) or coronary artery bypass surgery (n = 11). Cardiac function was evaluated by gated blood-pool scintigraphy (n = 26) or two-dimensional echocardiography (n = 8) before and after revascularization.

In 32 patients with reduced BMIPP uptake before revascularization, scintigraphic findings with 201Tl improved in 28 patients after revascularization. In these 28 patients, BMIPP uptake improved in 20 patients (71%). Wall motion abnormality was observed in 16 of these 20 patients before revascularization, with 15 showing wall motion improvement after revascularization. In eight patients without improvement of BMIPP uptake, despite 201Tl uptake improvement, wall motion abnormality was observed in four patients before revascularization; after revascularization, one showed wall motion recovery, and three did not. Ejection fraction (EF) improvement after revascularization correlated best with the area of improved BMIPP uptake (r = 0.84, p < 0.0005). EF improvement also correlated with the area of improved reinjection 201Tl uptake (r = 0.54, p < 0.05) and improved 201Tl uptake at stress after revascularization (r = 0.48, p < 0.05). The area of discordant uptake of BMIPP less than reinjection 201Tl uptake before revascularization was a good predictor of EF improvement after revascularization (r = 0.58, p < 0.01); however, the area of reversible 201Tl defect was not (r = 0.34, p = 0.15).

In patients with chronic coronary artery disease, functional improvement after revascularization is closely related to the recovery of BMIPP uptake. Discordant BMIPP uptake less than reinjection 201Tl uptake is a potential predictor of functional recovery.