Abstract 11926: Prognostic Utility of Myocardial Single Photon Emission Computed Tomography (SPECT) with Iodine-123-Beta-Methyl Iodophenyl-Pentadecanoic Acid (BMIPP) in Risk Stratification of Nonischemic Cardiomyopathy
Background: Iodine-123-beta-methyl iodophenyl-pentadecanoic acid (BMIPP) can assess myocardial fatty acid utilization. Recently, several reports have indicated that BMIPP imaging might identify ischemic injured myocardium in patients with coronary heart disease. However it is unknown whether BMIPP reflects myocardial injury and has prognostic value in patients with nonischemic cardiomyopathy (NICM).
Objective: The aim of this study was to evaluate the utility of BMIPP myocardial SPECT in predicting the long-term outcome in patients with NICM.
Method: We studied 278 consecutive NICM patients (left ventricular ejection fraction <50%) who were hospitalized because of heart failure, between January 2006 and June 2009. In all patients, coronary angiography or coronary CT angiography was performed to rule out coronary heart disease. In clinically stable states, dual myocardial SPECT using BMIPP and 201-thallium chloride (Tl) was performed and analyzed qualitatively in a blind manner. Positive findings (abnormal uptake of BMIPP) were interpreted from comparison with Tl perfusion images. In quantitative analysis, all images were divided into 17 segments. Each segment was graded on a 5-point scale based on averaged percent uptake, and mismatch score was calculated. The normal range in score of each segment was defined according to normal data base of the Japanese Society of Nuclear Medicine. Patients were followed for hard events (cardiac death and appropriate ICD therapy) and hospitalization for heart failure.
Results: All the patients were divided into positive finding group (Group A: n=147) and negative finding group (Group B; n=131). Mismatch score was significantly higher in group A than in group B (9.0 ± 3.9 vs. 2.2 ± 1.3 ). During a 3.0 ± 1.3-year follow-up, Group A had a higher incidence of hard events and hospitalization for heart failure than Group B (17.7% vs. 3.8%: P < 0.001, 27.2% vs. 10.6%: P < 0.001, respectively). In a multivariate analysis, positive finding of BMIPP and diabetes mellitus were identified as independent factors for cardiac events (p < 0.01).
Conclusion: Abnormal uptake of BMIPP in NICM patients can predict adverse cardiac outcome. Dual SPECT using BMIPP and Tl is a useful modality for the risk stratification in NICM patients.
- © 2011 by American Heart Association, Inc.