CARDIAC SPECT WITH IODINE-123-LABELED FATTY-ACIDS - EVALUATION OF MYOCARDIAL VIABILITY WITH BMIPP

The use of I-123-labeled fatty acids is witnessing a resurgence of int erest, primarily because of data from recent clinical protocols compar ing regional myocardial uptake of I-123-labeled 15-(p-iodophenyl)-3-(R ,S)-methylpentandecanoic acid (BMIPP) with flow tracers. Comparison of mismatches in BMIPP and flow tracer distribution (BMIPP < flow tracer ) has demonstrated the usefulness of evaluating myocardial viability w ith BMIPP. BMIPP was introduced in 1993 as ''Cardiodine'' as an approv ed radiopharmaceutical in Japan by Nihon Medi-Physics, Inc. This artic le reviews the clinical use of BMIPP in the assessment of cardiomyopat hy, myocardial infarction, ischemic heart disease and for the evaluati on of myocardial viability in comparison with PET tracers. The results of two specific protocols demonstrating the utility of using BMIPP to detect viable myocardium are described in detail. The first study com pares BMIPP and sestamibi uptake to wall motion and inotropic reserve after acute myocardial infarction in conjunction with two-dimensional echocardiography and low-dose dobutamine stimulation. The second examp le describes results of a triple SPECT technique using BMIPP reinjecti on for the assessment of ischemia.