title: Prognostic value of fatty acid imaging in patients with angina pectoris without prior myocardial infarction: comparison with stress thallium imaging.
abstract: A fatty acid analogue, 123I-labelled beta-methyl iodophenyl pentadecanoic acid (BMIPP), has been used to identify ischaemic and metabolically impaired myocardium. However, the prognostic value of BMIPP imaging, particularly in relation to stress myocardial perfusion imaging, remains unclear. Data from 167 consecutive patients with angina pectoris but without prior myocardial infarction (MI) who had undergone both BMIPP and stress 201Tl (sTL) imaging were analysed. Tracer uptake was graded using a 13-segment, 4-point scoring model. Patients were followed up for 48 months with primary end points (cardiac death, non-fatal MI) as hard cardiac events and with secondary end points (late revascularisation, recurrent angina and heart failure) as soft events. For overall cardiac events (5 hard and 29 soft events), Kaplan-Meier analysis revealed significantly lower event rates in subgroups with normal BMIPP uptake, a summed difference score of sTL (SDS) of <3 or absence of diabetes mellitus when compared to each counterpart. Multivariate Cox's analysis revealed reduced BMIPP uptake, SDS > or =3, diabetes and reduced ejection fraction to be significant predictors. Negative predictive values of normal BMIPP and SDS <3 for all events were 91% and 84%, respectively. No hard event occurred in 66 patients with normal BMIPP uptake, whereas two patients with SDS <3 but impaired BMIPP uptake had hard events. In conclusion, normal BMIPP imaging is an excellent prognostic sign, independently of stress myocardial perfusion imaging, in patients with angina pectoris without prior MI.
authors.affiliation: Department of Cardiology, Shin-Nittetsu Muroran General Hospital, Muroran, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsuki
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Doi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Michihiro
authors.initials: M
authors.lastname: Iwata
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Masaru
authors.initials: M
authors.lastname: Shimazaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Morita
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimamoto
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism*; D018572:Disease-Free Survival; D005080:Exercise Test; D005227:Fatty Acids / Q000378:metabolism* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D007462:Iodobenzenes / Q000493:pharmacokinetics*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013793:Thallium / Q000493:pharmacokinetics*
chemical_list: D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019275:Radiopharmaceuticals; C049338:iodofiltic acid; C027549:thallium chloride; D013793:Thallium