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Unlabelled: We previously reported that uptake of 123I-labeled 15-iodophenyl 3-methyl pentadecanoic acid (BMIPP) was lower than that of thallium in ischemic myocardium. Such discordant findings between BMIPP and thallium were compared with those of PET using 18F-deoxyglucose (FDG) and 11C-acetate to assess metabolic alterations in such segment., Methods: Sixteen patients with coronary artery disease underwent both BMIPP SPECT and PET. Relative FDG uptake (% FDG uptake) and the clearance rate constant (% Kmono) of 11C-acetate from the myocardium were calculated as markers of glucose and oxidative metabolism, respectively., Results: Relative FDG uptake of the myocardial segments with reduced BMIPP uptake and normal thallium uptake (discordant segments) was similar (85.3 +/- 10.3) to that of the normal segments (86.5 +/- 11.7) but higher than that of segments with reduced uptake of both BMIPP and thallium (67.5 +/- 19.9). Similarly, the discordant segments showed a higher % Kmono value (77.8 +/- 13.1 versus 70.0 +/- 19.1) and FDG-to-perfusion ratio (1.15 +/- 0.08 versus 1.01 +/- 0.22) than in the concordantly reduced segments., Conclusion: BMIPP uptake appears to provide metabolic information independent of thallium uptake. Combined imaging of BMIPP and thallium may potentially identify ischemic but viable myocardium.

The purpose of this study was to compare by planar myocardial scintigraphy the kinetics of iodine-123-15-(iodophenyl)pentadecanoic acid (123I-pPPA and 123I-oPPA), and of iodine-123-(p-iodophenyl)-3-R,S-methyl-pentadecanoic acid (BMIPP), firstly in normal baboons, and subsequently after blocking fatty acid oxidation by a carnitine palmitoyl transferase I(CPT1) inhibitor. The induced changes in myocardial metabolism were reflected in the dynamic behaviour of the three tracers. pPPA and oPPA to a large extent, provided information on beta-oxidation changes in the myocardium: beta-oxidation participation changed from 47% and 50%, respectively to 17% and 23% after inhibition. BMIPP provided better images and reflected largely on changed tracer incorporation into the neutral lipid pools. The beta-oxidation contributed only about 10% towards the metabolic pathway of BMIPP. The information obtained in this study could help determine the tracer of choice for SPECT, whereby myocardial viability could optimally be revealed.

The present study was undertaken to determine the potential diagnostic value of 123I-BMIPP scintigraphy for the detection of altered myocardial fatty acid metabolism in patients with unstable angina. Both myocardial metabolic imaging with 123I-BMIPP and perfusion imaging with 99mTc-sestamibi were performed at rest in 28 patients with unstable angina in the pain-free state. The regional uptakes of 123I-BMIPP or 99mTc-sestamibi were scored semiquantitatively (0 = normal, 4 = no activity) and compared with the coronary arteriographic findings. Decreased uptakes of 123I-BMIPP were observed in 18 patients, and 11 patients had abnormal 99mTc-sestamibi images. Defect scores of 123I-BMIPP were larger than those of 99mTc-sestamibi (7.8 +/- 2.1 vs. 5.2 +/- 1.9, p < 0.01). The sensitivity for the detection of patients with unstable angina was higher in 123I-BMIPP than in 99mTc-sestamibi (77% vs. 45%, p < 0.01). The site of the decreased 123I-BMIPP uptake corresponded to the most stenotic coronary artery lesion in all patients. Fatty acid metabolic imaging with 123I-BMIPP was more sensitive for detecting myocardial ischemia than perfusion imaging with 99mTc-sestamibi. 123I-BMIPP may be a clue to define the culprit lesion in unstable angina and be helpful to decide the best treatment and guide coronary angioplasty.

We estimated the systemic and left ventricular (LV) regional myocardial distribution of 123I-BMIPP (beta-methyl-p-iodophenyl-pentadecanoic-acid) in normal subjects (n = 13, mean age 43.9). In planar studies, the count ratios of heart, lung and liver to mediastinum were 2.63, 1.28 and 3.80 in the early images, and 2.23, 1.20 and 2.26 in the delayed images, respectively. The uptake in liver was almost identical with that in heart in the delayed images. In SPECT studies, the regional relative counts in anterior, septal, posterior and lateral LV walls were 100, 98, 96 and 108 (%) in the initial images, and 100, 98, 99 and 107 (%) in the delayed images, respectively. The regional relative uptake was significantly higher in the lateral wall than those in the other parts of LV walls in both images. The relative counts in the basal, mid- and apical portions were 100, 111 and 87 (%) in the initial images, and 100, 113, 92 (%) in the delayed images, respectively. These results suggest that the myocardial regional distribution of BMIPP is not always uniform even in normal subjects. Thus, it is necessary to interpret with caution in the light of these findings, especially for detect in a myocardial lesion in an early phase of cardiomyopathy or a mild myocardial ischemia.

Unlabelled: Increased clinical use of 123I-labeled 15-(p-iodophenyl)-3-(R,S)-methyl- pentadecanoic acid ([123I]BMIPP) revealed discordance between BMIPP uptake and that of perfusion agents, which was inexplicable due to the uncertainty of its myocardial metabolism. This study clarifies the metabolic fate of BMIPP and its relation to substrates in isolated rat hearts., Methods: Rat hearts were perfused with 5 mmole/liter HEPES buffer containing various energy substrates and 1% bovine serum albumin. The buffer was recirculated for 4 hr after bolus injection of [123I]BMIPP. Heart time-activity curves were monitored externally. After perfusion, the radioactivity in the heart and recirculated buffer was measured. The metabolites in the buffer were then extracted and analyzed by HPLC and TLC., Results: when 0.4 mmole/liter oleate was the energy substrate, more than eight radioactive BMIPP metabolites were detected. The metabolites in the coronary effluent depended on the energy substrate in the buffer. The radioactivity in the heart at the end of the perfusion period was significantly higher when 0.4 mmole/liter oleate (28.0% +/- 1.2% ID/g, mean +/- s.e.m.) or 10 mmole/liter glucose with 25 U/liter insulin (43.9% +/- 2.2% ID/g) were the substrates compared to when 5 mmole/liter acetate (8.5% +/- 0.4% ID/g) or 0.4 mmole/liter cold BMIPP (6.2% +/- 0.3% ID/g) were the substrates. The distribution of metabolites suggests that oleate stimulated both alpha and beta oxidations, whereas glucose with insulin inhibited both. Acetate also stimulated alpha oxidation but not beta oxidation. Cold BMIPP strongly inhibited both alpha- and beta-oxidations, and little alpha oxidation occurred compared to beta-oxidation., Conclusion: These results suggest that [123I]BMIPP is metabolized in the myocardium and the metabolism is closely related to myocardial carbohydrate utilization.

Iodine-123 beta-methyl iodophenylpentadecanoic acid (BMIPP) has been used for evaluating myocardial fatty acid metabolism in vivo. The whole body BMIPP imaging was acquired in 26 patients (11 with HCM, 11 with CAD and 4 with DCM) to calculate % uptake in the myocardium and to correlate its uptake with biochemical data, including blood sugar (BS), nonesterified fatty acid (NEFA) and insulin in the blood. BMIPP was administered at rest with overnight fasting state, and the anterior and posterior whole body imaging was performed one hour later. The background corrected whole myocardial counts were calculated to obtain %BMIPP uptake. In addition, the heart to mediastinum count ratio (H/M ratio) was calculated from the mean counts in the heart and the upper mediastinum in the anterior view. The %BMIPP uptake was 3.70 +/- 1.22% and H/M ratio was 2.30 +/- 0.23. The patients with DCM showed higher %BMIPP uptake values (DCM = 5.58 +/- 0.67% vs. CAD = 3.09 +/- 0.97% and HCM = 3.63 +/- 0.86%, both p < 0.01), but similar values of H/M ratio with other patients (DCM = 2.43 +/- 0.20, CAD = 2.22 +/- 0.25 and HCM = 2.32 +/- 0.20). Although the biochemical data varied at the time of the tracer administration, they were not significantly correlated with the %BMIPP uptake or H/M ratio. However, there was a significant correlation between %BMIPP uptake and H/M ratio with the correlation coefficient of 0.80 (p < 0.001). We conclude that the myocardial uptake of BMIPP is not influenced by the plasma substrate level under the fasting state.

To elucidate the metabolism of free fatty acid in the myocardium of hypertrophic cardiomyopathy (HCM), SPET was performed with 123I-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP), an analogue of free fatty acid, and with 201Tl in nine patients with HCM and eight healthy volunteers who acted as controls. For quantitative analysis of the apical area, a radial long-axis tomogram was reconstructed every 6 degrees after short-axis tomography. The relative regional uptake (RRU, %) in each segment was obtained by normalizing to the maximal value among all segments. The 3-h washout rate was calculated both for BMIPP and for 201Tl. The ratio of the RRU of BMIPP to that of 201Tl was significantly lower in the apical and antero-septal regions compared with other walls (P < 0.01) in the patients with HCM, whereas uptake of both BMIPP and 201Tl in the controls was homogeneous and there was a significant correlation between them. The coefficient of variation (CV) in all segments in the HCM patients was significantly higher (P < 0.01) than that of the controls both BMIPP and 201Tl, indicating inhomogeneous uptake of BMIPP in the HCM patients. The washout rate of BMIPP over 3 h was significantly higher in the patients with HCM (mean +/- S.D. 26.3 +/- 7.3%) than the controls (18.3 +/- 7.5%, P < 0.05). The ratio of segmental washout rate of BMIPP to that of 201Tl in the HCM patients was increased, especially in the septum and apex.(ABSTRACT TRUNCATED AT 250 WORDS)