A patient with type I CD36 deficiency whose myocardium accumulated 123I-BMIPP after 4 years.
A 73-year-old man with aortic regurgitation was examined by 123I-alpha-methyl-p-iodophenylpentadecanoic acid (BMIPP) myocardial single photon emission computed tomography (SPECT) in 1995. Myocardial accumulation was not evident on either the early or the delayed image obtained 15 minutes and 3 hours, respectively, after injecting 123I-BMIPP. Flow cytometric analysis of CD36 expression in monocytes and platelets identified a type I CD36 deficiency. The patient was hospitalized for severe heart failure in 1999. Upon admission, the cardiothoracic ratio on chest X-rays was 73%, and the left ventricular end-diastolic diameter on echocardiograms was enlarged to 77 mm. On the second day, we performed 123I-BMIPP myocardial SPECT. Myocardial accumulation was evident in the delayed, but not in the early image. We repeated 123I-BMIPP myocardial SPECT on the 10th day after admission. Myocardial accumulation was evident on both early and delayed images. 99mTc-tetrofosmin myocardial SPECT was immediately performed after 123I-BMIPP myocardial SPECT to distinguish myocardial from pooling images in the left ventricle, but, because the images from both 99Tc-tetrofosmin and 123I-BMIPP myocardial SPECT were idential, we considered that the 123I-BMIPP myocardial SPECT images reflected the actual myocardial condition. The CD36 molecule transports long-chain fatty acid (LCFA) on the myocardial membrane, but 123I-BMIPP scintigraphy does not show any myocardial accumulation in patients with type I CD36 deficiency, indicating that myocardial LCFA uptake occurs through CD36 on the human myocardial membrane. Even though our patient had type I CD36 deficiency, BMIPP was uptaken by the myocardium during heart failure, suggesting a variant pathway on the human myocardial membrane for LCFA uptake.
Ito
K
K
Division of Cardiology, Murakami Memorial Hospital, Asahi University, Gifu, Japan. kazuki@poppy.ocn.ne.jp
Sugihara
H
H
Tanabe
T
T
Zen
K
K
Hikosaka
T
T
Adachi
Y
Y
Katoh
S
S
Azuma
A
A
Nakagawa
M
M
D000368:Aged; D015703:Antigens, CD / Q000097:blood / Q000235:genetics; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging*; D018955:CD36 Antigens / Q000097:blood / Q000235:genetics*; D005227:Fatty Acids / Q000493:pharmacokinetics*; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000000981:diagnostic imaging; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics*; D007462:Iodobenzenes / Q000493:pharmacokinetics*; D008297:Male; D013997:Time Factors; D014018:Tissue Distribution; D015899:Tomography, Emission-Computed, Single-Photon
D015703:Antigens, CD; D018955:CD36 Antigens; D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; C049338:iodofiltic acid