Morimoto K, Tomoda H, Yoshitake M, Aoki N, Handa S, Suzuki Y
Department of Cardiology, Tokai University Hospital, Isehara, Kanagawa, Japan.
Angiology. 1999 Aug;50(8):639-48. doi: 10.1177/000331979905000804.
Iodine 123 beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP), a beta-methyl-branched fatty acid analogue, has been proven by experimental studies to reveal abnormalities in fatty-acid-related metabolism. This study was undertaken to validate the accuracy and limitations of 123I-BMIPP imaging at rest in detecting myocardial metabolic abnormalities and predicting coronary lesions in unstable angina (UA). One hundred UA patients without prior myocardial infarction were studied. 123I-BMIPP and thallium 201 chloride (201TlCl) imaging with single photon emission computed tomography (SPECT) and coronary and left ventricular cineangiography (LVC) were performed 1 week after the last episode of angina. There was reduced uptake of 123I-BMIPP imaging in 70 patients, reduced uptake of 201TlCl in 41, and abnormal LVC contraction in 49 patients. There were significant increases in severity scores of 123I-BMIPP imaging along with increases in the number of stenosed coronary arteries and the severity of stenosis in individual coronary arteries. There was a significant reduction in 123I-BMIPP severity scores 1 month after percutaneous transluminal coronary angioplasty (p < 0.01) and a significant correlation between the severity scores of 123I-BMIPP and LVC (r=0. 579, p<0.001). Overall rates of sensitivity and specificity in detecting significant coronary stenosis by 123I-BMIPP imaging were 74% and 86%, respectively, whereas rates of sensitivity and specificity in detecting significant coronary stenosis by 201TlCl were 31% and 91%, respectively. 123I-BMIPP sensitivity increases to 86% if only advanced coronary stenosis of >90% is included. In conclusion, 123I-BMIPP myocardial imaging is an effective method of predicting coronary artery lesions of UA patients without provocative test.
碘 123β-甲基碘代苯十五烷酸(123I-BMIPP),一种β-甲基支链脂肪酸类似物,经实验研究已证实其可揭示脂肪酸相关代谢异常。本研究旨在验证静息状态下 123I-BMIPP 显像在检测不稳定型心绞痛(UA)患者心肌代谢异常及预测冠状动脉病变方面的准确性和局限性。对 100 例既往无心肌梗死的 UA 患者进行了研究。在最后一次心绞痛发作 1 周后,采用单光子发射计算机断层扫描(SPECT)进行 123I-BMIPP 和氯化铊 201(201TlCl)显像,并进行冠状动脉和左心室电影血管造影(LVC)。70 例患者 123I-BMIPP 显像摄取减低,41 例 201TlCl 摄取减低,49 例患者 LVC 收缩异常。随着冠状动脉狭窄数量的增加及各冠状动脉狭窄程度的加重,123I-BMIPP 显像严重程度评分显著增加。经皮冠状动脉腔内血管成形术后 1 个月,123I-BMIPP 严重程度评分显著降低(p < 0.01),且 123I-BMIPP 严重程度评分与 LVC 之间存在显著相关性(r = 0.579,p < 0.001)。123I-BMIPP 显像检测显著冠状动脉狭窄的总体敏感性和特异性分别为 74%和 86%,而 201TlCl 检测显著冠状动脉狭窄的敏感性和特异性分别为 31%和 91%。若仅纳入狭窄程度>90%的重度冠状动脉狭窄,123I-BMIPP 的敏感性可增至 86%。总之,123I-BMIPP 心肌显像无需激发试验即可有效预测 UA 患者的冠状动脉病变。