I-123 labeled methyl-branched fatty acid, BMIPP, has been used mainly in Eu
rope and Japan for the evaluation of various cardiac diseases. BMIPP uptake
abnormality is usually more prominent than perfusion, representing discord
ant BMIPP uptake less than thallium. This finding is observed in various ca
rdiac disease conditions such as acute myocardial infarction, stable and un
stable angina, hypertrophic and dilated cardiomyopathies. Many BMIPP studie
s combined stress thallium imaging in patients with coronary artery disease
and hypertrophic cardiomyopathy demonstrated that such discordant BMIPP up
take less than thallium is related to stress-induced ischemia as evidenced
by reversible thallium defect after exercise. BMIPP imaging is able to dete
ct metabolic alteration in the heart which is not available by perfusion im
aging alone.