Inoue Aritomo, Fujimoto Shinichiro, Yamashina Shohei, Yamazaki Junichi
Department of Cardiovascular Medicine, Toho University Omori Medical Center, 6-11-1 Ohmori-nishi, Tokyo, 143-8541, Japan.
Ann Nucl Med. 2007 Sep;21(7):399-404. doi: 10.1007/s12149-007-0045-8. Epub 2007 Sep 25.
Various clinical trials for dilated cardiomyopathy (DCM) have demonstrated that the prognosis as well as cardiac function is improved by the administration of beta-blocker therapy. On the other hand, 123I-betamethyl-p-iodophenyl-pentadecanoic acid (BMIPP) reflects myocardial fatty acid metabolism and is considered to be a more sensitive tracer than perfusion tracers. In this study, the efficacy of DCM for the evaluation of myocardial damage and the prediction of cardiac events was studied using 123I-BMIPP and 201TI (Tl) myocardial scintigraphy.
Study subjects comprised 33 DCM patients, divided into a cardiac event group (event, n = 9) and an event-free group (event free, n = 24). An extent score (ES) and severity score (SS) were calculated for each BMIPP image. BMIPP and Tl images were divided into 17 segments, and total defect scores (TDS) were calculated for each. The TDS of the BMIPP and Tl images were compared with score differences greater than or equal to 4 and less than 4 defined as mismatch and non-mismatch, respectively.
The TDS of BMIPP was significantly higher in the event group than in the event-free group (P < 0.05). The ES and SS were significantly higher in the event group than in the event-free group (P < 0.01). The comparison in the 2 x 2 contingency tables showed that the occurrence of non-mismatch was significantly higher in the event-free group (chi2 test; P < 0.01). The ES of BMIPP was a significant predictor of cardiac events in the multivariate analysis (P < 0.01).
These results suggest that the ES for BMIPP is useful as a predictor of cardiac events in DCM.
多项针对扩张型心肌病（DCM）的临床试验表明，使用β受体阻滞剂治疗可改善预后及心脏功能。另一方面，123I - 甲基 - 对碘苯基 - 十五烷酸（BMIPP）可反映心肌脂肪酸代谢，且被认为是比灌注示踪剂更敏感的示踪剂。在本研究中，使用123I - BMIPP和201铊（Tl）心肌闪烁显像研究了DCM在评估心肌损伤和预测心脏事件方面的有效性。
研究对象包括33例DCM患者，分为心脏事件组（事件组，n = 9）和无事件组（无事件组，n = 24）。为每个BMIPP图像计算范围评分（ES）和严重程度评分（SS）。将BMIPP和Tl图像分为17个节段，并分别计算每个节段的总缺损评分（TDS）。将BMIPP和Tl图像的TDS进行比较，差值大于或等于4和小于4分别定义为不匹配和匹配。
事件组中BMIPP的TDS显著高于无事件组（P < 0.05）。事件组的ES和SS显著高于无事件组（P < 0.01）。2×2列联表比较显示，无事件组中匹配的发生率显著更高（卡方检验；P < 0.01）。在多因素分析中，BMIPP的ES是心脏事件的显著预测指标（P < 0.01）。
这些结果表明，BMIPP的ES可作为DCM心脏事件的预测指标。
