title: Comparison of perfusion-metabolism mismatch in 99mTc-MIBI and 123I-BMIPP scintigraphy with cardiac magnetic resonance in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  Cardiac magnetic resonance (CMR) imaging is an established method of detecting myocardial fibrosis related to prognosis in patients with dilated cardiomyopathy (DCM). Recent studies have found that (99m)Tc-methoxy-isobutyl-isonitrile (MIBI) and (123)I-15-(p-iodophenyl)-3(R,S)-methylpentadecanoic acid (BMIPP) dual single-photon-emission computerized tomography (MIBI-BMIPP dual SPECT) can detect perfusion-metabolism mismatches. We compared MIBI-BMIPP dual SPECT with CMR findings and assessed their prognostic abilities to determine the significance of abnormal metabolism in patients with DCM.
  
  
  RESULTS
  Fifty inpatients with DCM (age 58 ± 12 y; 14 female) were assessed with the use of MIBI-BMIPP dual SPECT and CMR. Perfusion-metabolism mismatches were identified mainly at the left ventricular free wall, whereas late gadolinium enhancement (LGE) was evident mostly at the septal wall. During a median follow-up of 33 months, 9 patients developed cardiac events including death, heart failure, and fatal arrhythmia. Event-free survival rates were significantly lower for patients with LGE plus a mismatch than with other abnormalities (P = .001). Among clinical and imaging variables, LGE plus a mismatch was significantly associated with cardiac events (hazard ratio 7.9, 95% confidence interval 1.8-35.6; P = .007).
  
  
  CONCLUSIONS
  Coexisting LGE and a perfusion-metabolism mismatch accurately predict future cardiac events in patients with DCM.
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Asuka
authors.initials: A
authors.lastname: Yoshida
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takano
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasutake
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Amano
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Kumita
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000378:metabolism*; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000378:metabolism*; D007462:Iodobenzenes / Q000378:metabolism*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi / Q000378:metabolism*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; C049338:iodofiltic acid; D017256:Technetium Tc 99m Sestamibi
keywords: Fatty acid metabolism; late gadolinium enhancement; single-photon-emission computerized tomography