ABSENCE OF MYOCARDIAL I-123 BMIPP UPTAKE IN THE PRESENCE OF A NORMAL CORONARY ANGIOGRAM AND NORMOKINETICS ON A LEFT VENTRICULOGRAM

We present the case of a 44-year-old man with abnormal myocardial fatt y acid metabolism who exhibited no myocardial uptake of I-123-beta-met hyl- iodophenyl pentadecanoic acid (I-123-BMIPP). This patient present ed to our hospital with an ECG abnormality detected during a medical c heck-up. He felt no chest discomfort, but a 12-lead ECG at rest showed flat T-waves in leads I, V5, and V6 with no marked ischemic changes d uring exercise. A left ventriculogram and coronary angiograms were nor mal. Thallium-201 single photon emission computed tomography imaging r evealed a normal myocardial uptake, but I-123-BMIPP imaging showed no such uptake. However, F-18-labelled fluorodeoxyglucose positron emissi on tomography imaging after an overnight fast showed a marked increase in myocardial uptake. It appears that myocardial uptake of I-123-BMIP P was totally lacking and that energy production by the myocardium dur ing fasting depended on the metabolism of glucose rather than of fatty acids.