BMIPP imaging to improve the value of sestamibi scintigraphy for predicting functional outcome in severe chronic ischemic left ventricular dysfunction

Mismatching between beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and perfusion accurately predicts functional outcome after acute myocardial in farction. The current investigation was aimed at evaluating the value of th is method to predict the evolution of global function according to the appl ied treatment in patients with chronic ischemic heart disease. Methods: Twe nty patients with infarction and chronic left ventricular dysfunction were studied (median infarction age 12 wk, range 2 wk-15 y). Radionuclide angiog raphy, two-dimensional echocardiography and BMIPP and gated sestamibi scint igraphy were performed with the patient at rest before and >6 mo after trea tment (revascularization in 13 patients and conservative therapy in 7 patie nts). In 7 patients, radionuclide angiography was repeated after 1 y. Resul ts: On a patient basis, mismatching with BMIPP less than sestamibi was note d in 15 patients at baseline. Of these 15 patients, 11 had significant func tional improvement at follow-up versus only 1 of the 5 patients with a matc hed decreased uptake. Hence, the combined sestamibi/BMIPP was 73% positive and 80% negative in predicting functional outcome, with a global accuracy o f 75%. On a segmental basis, using an optimal threshold of uptake defined b y receiver operating characteristic curve analysis, sestamibi was only 63% accurate in predicting regional outcome. Adding BMIPP improved the accuracy to 80% (P = 0.001). At follow-up, significant mismatching was still noted in 7 patients in the revascularized group and 1 in the medically treated gr oup. The mismatch was associated with a further increase in ejection fracti on at 1-y follow-up in only the revascularized group. Conclusion: In patien ts with chronic left ventricular dysfunction after infarction, a mismatchin g with BMIPP less than sestamibi reliably identifies jeopardized but viable myocardium and predicts functional recovery with an accuracy similar to th at reported in the acute and subacute phases of the infarction.