Prediction of cardiac events in patients with dilated cardiomyopathy using 123I-BMIPP and 201Tl myocardial scintigraphy.
OBJECTIVE
Various clinical trials for dilated cardiomyopathy (DCM) have demonstrated that the prognosis as well as cardiac function is improved by the administration of beta-blocker therapy. On the other hand, 123I-betamethyl-p-iodophenyl-pentadecanoic acid (BMIPP) reflects myocardial fatty acid metabolism and is considered to be a more sensitive tracer than perfusion tracers. In this study, the efficacy of DCM for the evaluation of myocardial damage and the prediction of cardiac events was studied using 123I-BMIPP and 201TI (Tl) myocardial scintigraphy.


METHODS
Study subjects comprised 33 DCM patients, divided into a cardiac event group (event, n = 9) and an event-free group (event free, n = 24). An extent score (ES) and severity score (SS) were calculated for each BMIPP image. BMIPP and Tl images were divided into 17 segments, and total defect scores (TDS) were calculated for each. The TDS of the BMIPP and Tl images were compared with score differences greater than or equal to 4 and less than 4 defined as mismatch and non-mismatch, respectively.


RESULTS
The TDS of BMIPP was significantly higher in the event group than in the event-free group (P < 0.05). The ES and SS were significantly higher in the event group than in the event-free group (P < 0.01). The comparison in the 2 x 2 contingency tables showed that the occurrence of non-mismatch was significantly higher in the event-free group (chi2 test; P < 0.01). The ES of BMIPP was a significant predictor of cardiac events in the multivariate analysis (P < 0.01).


CONCLUSIONS
These results suggest that the ES for BMIPP is useful as a predictor of cardiac events in DCM.
Inoue
Aritomo
A
Department of Cardiovascular Medicine, Toho University Omori Medical Center, 6-11-1 Ohmori-nishi, Tokyo, 143-8541, Japan. a-inoue@med.toho-u.ac.jp
Fujimoto
Shinichiro
S
Yamashina
Shohei
S
Yamazaki
Junichi
J
D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000000981:diagnostic imaging*; D005227:Fatty Acids / Q000378:metabolism / Q000493:pharmacokinetics; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D007462:Iodobenzenes / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; 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