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Clinical significance of decreased myocardial uptake of 123I‐BMIPP in patients with stable effort angina pectoris

SummaryThe aim of this study was to assess the feasibility of resting myocardial fatty acid metabolic imaging with 123I-beta-methyliodophenyl-pentadecanoic acid (123I-BMIPP) for the detection of patients with stable effort angina pectoris and to clarify the clinical significance of abnormal 123I-BMIPP images. Myocardial imaging with 123I-BMIPP at rest and 99Tcm-methoxyisobutyl isonitrile (99Tcm-MIBI) at rest and during treadmill exercise was performed in 46 patients with suspected effort angina pectoris. Resting 123I-BMIPP imaging detected 43% (17/40) of patients with significant (≥ 50%) coronary artery stenosis and 59% (17/29) of patients with exercise-induced myocardial ischaemia. The patients with abnormal 123I-BMIPP images terminated exercise after a shorter period (4.5 ± 2.6 vs 6.7 ± 4.1 min; P > 0.01) and at a lower rate pressure product (16,124 ± 5211 vs 20,246 ± 6564 mmHg × beats min-1; P > 0.01) than those with normal 123I-BMH>P images. The presence of ST depression during the exercise test (77 vs 52%; P > 0.05), severe coronary stenosis exceeding 90% (88 vs 43%; P > 0.01), collateral vessels (35 vs 9%; P > 0.01) and a wall motion abnormality of hypokinesis/akinesis (53 vs 30%; P > 0.05) were more frequently seen in patients with abnormal 123I-BMIPP images than in those with normal images. Resting 123I-BMIPP imaging was able to detect the presence of coronary artery stenosis and exercise-induced myocardial ischaemia with moderate sensitivity, and to determine the functional severity of coronary artery disease.