Assessment of myocardial fatty acid metabolic abnormalities in patients with idiopathic dilated cardiomyopathy using 123I BMIPP SPECT: correlation with clinicopathological findings and clinical course.

Abstract

OBJECTIVE:

To determine the clinical and prognostic value of identifying metabolic abnormalities of myocardial fatty acid metabolism in idiopathic dilated cardiomyopathy using iodine-123 beta-methyl-iodophenyl pentadecanoic acid (123I BMIPP).

SETTING:

Cardiac care division in national hospital.

PATIENTS:

32 consecutive patients with idiopathic dilated cardiomyopathy in whom both 123I BMIPP and thallium-201 myocardial single photon emission computed tomography were performed.

METHODS:

The uptake of each tracer was scored visually from 0 (normal) to 3 (defect) in 17 segments (eight basal, eight midventricular, and one apical). A total score for all 17 segments was compared with clinicopathological variables. Prognostic value of mismatches between the two tracers were also evaluated.

RESULTS:

The 123I BMIPP total score was correlated with pulmonary capillary wedge pressure (r = 0.68, p < 0.001), left ventricular end diastolic pressure (r = 0.65, p < 0.001), percentage fractional shortening at six months' follow up (r = -0.58, p = 0. 001), myocyte diameter (r = 0.66, p < 0.001), and percentage area of interstitial fibrosis (r = 0.69, p < 0.001) measured by morphometry in the biopsy specimens. During a mean (SD) follow up of 20 (11) months, deterioration of the New York Heart Association functional class was observed in 11 of the 32 patients; four of these died. Segments with a greater decrease in 123I BMIPP than thallium-201 uptake (type B mismatching) were often observed in patients with deterioration (88/187, 29% v 58/357, 16%; p < 0.001).

CONCLUSIONS:

The extent of the abnormality of myocardial fatty acid metabolism in idiopathic dilated cardiomyopathy reflects the severity of haemodynamic deterioration and histopathological changes. Type B mismatching is one of the important prognostic indicators in idiopathic dilated cardiomyopathy.

• Authors: Y Yazaki, M Isobe, W Takahashi, H Kitabayashi, O Nishiyama, M Sekiguchi, T Takemura
• Journal: Heart (British Cardiac Society) (Heart) Vol. 81 Issue 2 Pg. 153-9 (Feb 1999) ISSN: 1355-6037 [Print] England
• PMID: 9922350 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Fatty Acids
• Iodobenzenes
• Thallium Radioisotopes
• iodofiltic acid

Topics

• Adult
• Aged
• Cardiac Catheterization
• Cardiomyopathy, Dilated (diagnostic imaging, metabolism, pathology)
• Chi-Square Distribution
• Echocardiography
• Fatty Acids (metabolism)
• Female
• Follow-Up Studies
• Humans
• Iodobenzenes
• Linear Models
• Male
• Middle Aged
• Myocardium (metabolism, pathology)
• Predictive Value of Tests
• Pulmonary Wedge Pressure
• Thallium Radioisotopes
• Tomography, Emission-Computed, Single-Photon
• Ventricular Pressure