ASSESSMENT OF IMPROVEMENT OF MYOCARDIAL FATTY-ACID UPTAKE AND FUNCTION AFTER REVASCULARIZATION USING IODINE-123-BMIPP

We used beta-methyl iodophenyl pentadecanoic acid (BMIPP) to evaluate changes in myocardial fatty acid utilization before and after revascul arization and the ability of BMIPP to predict functional recovery in p atients with chronic coronary artery disease. Methods: Thirty-four pat ients with chronic coronary artery disease (60 +/- 10 yr) underwent BM IPP and Tl-201 SPECT (stress-reinjection Tl-201 in 29 patients and res ting Tl-201 in 5 patients) before and 2-5 wk after percutaneous transl uminal angioplasty (n = 23) or coronary artery bypass surgery (n = 11) . Cardiac function was evaluated by gated blood-pool scintigraphy (n = 26) or two-dimensional echocardiography (n = 8) before and after reva scularization. Results: In 32 patients with reduced BMIPP uptake befor e revascularization, scintigraphic findings with Tl-201 improved in 28 patients after revascularization, In these 28 patients, BMIPP uptake improved in 20 patients (71%), Wall motion abnormality was observed in 16 of these 20 patients before revascularization, with 15 showing wal l motion improvement after revascularization. In eight patients withou t improvement of BMIPP uptake, despite Tl-201 uptake improvement, wall motion abnormality was observed in four patients before revasculariza tion; after revascularization, one showed wall motion recovery, and th ree did not, Ejection fraction (EF) improvement after revascularizatio n correlated best with the area of improved BMIPP uptake (r = 0.84, p < 0.0005), EF improvement also correlated with the area of improved re injection Tl-201 uptake (r = 0.54, p < 0.05) and improved Tl-201 uptak e at stress after revascularization (r = 0.48, p 0.05), The area of di scordant uptake of BMIPP less than reinjection Tl-201 uptake before re vascularization was a good predictor of EF improvement after revascula rization (r = 0.58, p < 0.01); however, the area of reversible Tl-201 defect was not (r = 0.34, p = 0.15), Conclusion: In patients with chro nic coronary artery disease, functional improvement after revasculariz ation is closely related to the recovery of BMIPP uptake. Discordant B MIPP uptake less than reinjection Tl-201 uptake is a potential predict or of functional recovery.