title: Prognostic value of impaired myocardial fatty acid uptake in patients with acute myocardial infarction.
abstract: Impaired cardiac fatty acid uptake, assessed by the radiolabelled fatty acid analogue beta-methyl-p-iodophenyl pentadecanoic acid (I-123-BMIPP), is observed in the myocardium following acute ischaemic events, but the long-term prognostic implication has not been established. This study aimed to determine the prognostic value of cardiac BMIPP uptake in patients with acute myocardial infarction. Following the assessment of thallium-201 and I-123-BMIPP uptake, 101 post-infarct patients were prospectively followed up with primary end points of cardiac death, heart failure and non-fatal infarction. During a mean follow-up of 28 months, three cardiac deaths, three non-fatal infarctions, 23 revascularizations and four recurrences of angina pectoris were observed. Multivariate analysis identified reduced uptake of BMIPP and perfusion, no beta-blocking treatment and greater thallium-BMIPP mismatch (i.e. larger BMIPP defect than thallium defect) as significant predictors for overall cardiac events. Prior myocardial infarction, reduced left ventricular ejection fraction and greater thallium-BMIPP mismatch were selected as independent predictors of harder cardiac events. Female patients, those with greater BMIPP defect or greater thallium-BMIPP mismatch showed worse clinical outcomes. The inclusion of BMIPP data improved the prognostic values of conventional significant predictors. In conclusion, impaired myocardial I-123-BMIPP uptake and perfusion-BMIPP mismatch are related to a high probability of fatal and non-fatal cardiac events, suggesting the aetiological relevance and prognostic value of impaired cardiac fatty acid metabolism in viable, but jeopardized, myocardium following acute myocardial infarction.
authors.affiliation: Sapporo Medical University, Japan. tnakata@sapmed.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Nakata
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
authors.forename: N
authors.initials: N
authors.lastname: Tamaki
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Wakabayashi
authors.forename: S
authors.initials: S
authors.lastname: Shimoshige
authors.forename: K
authors.initials: K
authors.lastname: Oh-Hori
authors.forename: K
authors.initials: K
authors.lastname: Hamabe
authors.forename: K
authors.initials: K
authors.lastname: Hirasawa
authors.forename: T
authors.initials: T
authors.lastname: Matsuki
authors.forename: T
authors.initials: T
authors.lastname: Shogase
authors.forename: M
authors.initials: M
authors.lastname: Furudate
authors.forename: K
authors.initials: K
authors.lastname: Shimamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001693:Biological Transport, Active; D016757:Death, Sudden, Cardiac; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D013794:Thallium Radioisotopes
chemical_list: D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C049338:iodofiltic acid