CLINICAL STUDY: MYOCARDIAL ISCHEMIA
Significance of reduced uptake of iodinated fatty acid analogue for the evaluation of patients with acute chest pain
Yuko Kawai, MD*,
Eriko Tsukamoto, MD ,
Yoichi Nozaki, MD*,
Koichi Morita, MD,
Masayuki Sakurai, MD* and
Nagara Tamaki, MD*,*
* Department of Cardiovascular Medicine, Hokko Memorial Hospital, Sapporo, Japan
Department of Nuclear Medicine, Hokkaido University, School of Medicine, Sapporo, Japan
Manuscript received October 3, 2000;
revised manuscript received July 24, 2001,
accepted August 20, 2001.
* Reprint requests and correspondence: Dr. Nagara Tamaki, Hokkaido University, School of Medicine, Department of Nuclear Medicine, Kita 15, Nishi 7, Sapporo, 060-8638, Japan
natamaki{at}med.hokudai.ac.jp
OBJECTIVES
To assess whether 15-(p-[iodine-123] iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) imaging can identify previous ischemic areas, BMIPP SPECT was performed in patients with acute chest pain to compare its findings with those of technetium-99m–tetrofosmin (tetrofosmin) SPECT and coronary angiography.
BACKGROUND
Basic studies indicate that BMIPP can identify previous ischemia as reduced tracer uptake.
METHODS
This study prospectively enrolled 111 consecutive patients with acute chest pain without myocardial infarction. Tetrofosmin SPECT was performed at rest within 24 h after the last episode of chest pain. Coronary angiography and BMIPP SPECT were also performed on the following day.
RESULTS
Sixty-four of the 87 patients with coronary stenosis or spasm showed BMIPP abnormalities corresponding to the areas of coronary abnormalities (sensitivity 74%), whereas only 33 of them showed perfusion abnormalities (sensitivity 38%) (p < 0.001). Of the 24 patients without coronary stenosis or spasm, 22 showed normal BMIPP SPECT (specificity 92%), and 23 showed normal tetrofosmin SPECT (sensitivity 96%). Coronary stenosis was more often seen in the group with abnormal tetrofosmin/abnormal BMIPP (82%) and with normal tetrofosmin/abnormal BMIPP (69%) than in the group with normal tetrofosmin/normal BMIPP (36%) (p < 0.05). Coronary spasm was observed more often in the group with abnormal tetrofosmin/abnormal BMIPP (83%) and with normal tetrofosmin/abnormal BMIPP (90%) than in the group with normal tetrofosmin/normal BMIPP (27%) (p < 0.05). The extent and severity scores of tetrofosmin and BMIPP in the patients with organic stenosis were significantly higher than those of patients with no organic stenosis or spasm (p < 0.0001).
CONCLUSIONS
These data indicate that BMIPP SPECT may specifically identify previous ischemic lesions due to coronary stenosis or spasm in patients with acute chest pain.
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Abbreviations and Acronyms
| | BMIPP | = 15-(p-[iodine-123] iodophenyl)-3-(R,S) methylpentadecanoic acid | | ECG | = electrocardiogram or electrocardiographic | | LAD | = left anterior descending coronary artery | | LCx | = left circumflex coronary artery | | MI | = myocardial infarction | | PET | = positron emission tomography | | RCA | = right coronary artery | | SPECT | = single-photon emission computed tomography |
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