Latent abnormal fatty acid metabolism in apparently normal perfusion during stress in patients with restenosis after coronary angioplasty: assessment by exercise stress thallium-201 and iodine-123-labeled 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid-dual myocardial single-photon emission computed tomography.
Restenosis is a major problem in patients undergoing coronary angioplasty. Reduced uptake of iodine-123-labeled 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (I-BMIPP-123) relatively to thallium-201 (Tl-201) has been attributed to the metabolic damage in the myocardium in patients with coronary artery disease. Therefore, we performed exercise stress Tl-201 and I-BMIPP-123 dual myocardial single-photon emission computed tomography (SPECT) to detect coronary restenosis in 48 patients (35 men and 13 women, mean age 66 +/- 8 years), followed by coronary angiography at follow-up. Patients were divided into 2 groups: those with (n = 24) and without (n = 24) restenosis. Redistribution of Tl-201 was seen more frequently in the restenosis group than in no-restenosis group (58% [14 of 24] vs 8% [2 of 24], p <0.05). Five of 10 patients (50%) with restenosis but without Tl-201 redistribution had Tl-201/I-BMIPP-123 discrepancy during stress. In patients without restenosis, only 1 patient had this discrepancy during stress. Incorporation of Tl-201/I-BMIPP-123 uptake discrepancy during stress significantly improved the sensitivity (58% [14 of 24] to 79% [19 of 24]) with preserved specificity (92% [22 of 24] to 88% [21 of 24]). Exercise stress Tl-201 and I-BMIPP-123 dual myocardial SPECT revealed that latent abnormal fatty acid metabolism may exist in apparently normal perfusion during stress in patients with restenosis after coronary angioplasty. Use of I-BMIPP-123 together with Tl-201 during stress SPECT substantially improved the diagnostic accuracy of restenosis based on Tl-201 redistribution (from 75% to 83%).
Iwado
Hiromi
H
Second Department of Internal Medicine, Kagawa, Japan. iwado@kms.ac.jp
Iwado
Yasuyoshi
Y
Ohmori
Koji
K
Mizushige
Katsufumi
K
Yukiiri
Kazushi
K
Takagi
Yuichiro
Y
Nishiyama
Yoshihiro
Y
Tamaki
Nagara
N
Senda
Shoichi
S
Kohno
Masakazu
M
D000368:Aged; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000378:metabolism; D023903:Coronary Restenosis; D005080:Exercise Test; D005227:Fatty Acids / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics*; D007462:Iodobenzenes / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D012680:Sensitivity and Specificity; D013312:Stress, Physiological; D013794:Thallium Radioisotopes / Q000493:pharmacokinetics*; D015899:Tomography, Emission-Computed, Single-Photon
D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C049338:iodofiltic acid