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Heart 1999;81:153-159; doi:10.1136/hrt.81.2.153
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1999;81:153-159 ( February )

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

Y Yazaki,a M Isobe,b W Takahashi,a H Kitabayashi,b O Nishiyama,a M Sekiguchi,b T Takemuraa

a Division of Cardiology, National East Nagano Hospital, Nagano, Japan, b First Department of Internal Medicine, Shinshu University, Asahi 3-1-1, Matsumoto 390, Japan

Correspondence to: Dr Isobe.

Accepted for publication 7 September 1998

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.

Keywords: idiopathic dilated cardiomyopathy; fatty acid metabolism; beta -methyl-iodophenyl pentadecanoic acid

© 1999 by Heart
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