In the present study, the effectiveness of 123I-beta-methyliodophenyl
pentadecanoic acid (
BMIPP) single photon emission computed tomography (SPECT) for predicting
cardiac death of patients with chronic
heart failure was evaluated. Abnormalities of
fatty acid metabolism are found in patients with chronic
heart failure and
BMIPP was developed as a tracer for scintigraphic assessment of myocardial
fatty acid utilization. The study group comprised 74 patients with chronic
heart failure with a left ventricular ejection fraction (LVEF) <45% on left ventriculography or
radionuclide angiocardiography. They underwent both 201Tl SPECT and
BMIPP SPECT. The uptake of tracer was scored semiquantitatively from 0 (normal) to 4 (defect) in 20 segments and a total defect score (
TDS) for all 20 segments was calculated. On planar images the mediastinum to heart count ratio (H/M) was calculated for the
BMIPP and Tl studies, and the H/M(
BMIPP):H/M(Tl) (H/M(
BMIPP) divided by H/M(Tl)) was also calculated. The mean follow-up period was 660 days and there were 17 cases of
cardiac death. Multivariate analysis identified H/M(
BMIPP):H/M(Tl) (p<0.05) and LVEF (p<0.05) as independent predictors of
cardiac death. The receiver-operating characteristic curve of H/M(
BMIPP):H/M (Tl) was situated to the left relative to LVEF. Analysis of the myocardial metabolism by
BMIPP SPECT can predict the high-risk patients with chronic
heart failure.