Prognostic value of impaired myocardial fatty acid uptake in patients with acute myocardial infarction.
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.
Nakata
T
T
Sapporo Medical University, Japan. tnakata@sapmed.ac.jp
Kobayashi
T
T
Tamaki
N
N
Kobayashi
H
H
Wakabayashi
T
T
Shimoshige
S
S
Oh-Hori
K
K
Hamabe
K
K
Hirasawa
K
K
Matsuki
T
T
Shogase
T
T
Furudate
M
M
Shimamoto
K
K
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
D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C049338:iodofiltic acid