Kobayashi H, Nakata T, Han S, Takahashi N, Hashimoto A, Tsuchihashi K, Nagao K, Tanaka S, Shimamoto K, Iimura O
Second Department of Internal Medicine, School of Medicine, Sapporo Medical University.
J Cardiol. 1994 Jan-Feb;24(1):35-43.
Fatty acid metabolic and perfusion abnormalities associated with cardiac hypertrophy were investigated using dual tracer tomography with thallium and a cardiac metabolic tracer, 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP), in eight patients with hypertrophic cardiomyopathy (HCM) and in three with hypertension (HT). Thallium and BMIPP uptakes were scored and analyzed in 143 segments (13/heart) by comparison with the left ventricular wall thickness measured by two-dimensional echocardiography. Complete agreement of both scores in HT patients was significantly higher than that in HCM patients (64% vs 24%, p < 0.001), while a lower BMIPP uptake compared to that of thallium (mismatching) was observed more frequently in HCM than in HT patients (65% vs 31%, p < 0.001). The wall thickness significantly (p < 0.005) correlated with BMIPP uptake score. HCM patients showed a low BMIPP uptake in 22 hypertrophic segments (59%) and 15 non-hypertrophic segments (41%), and reduced BMIPP uptake in 29% hypertrophic segments, while HT patients showed just five segments with decreased BMIPP uptake of which 4 were non-hypertrophic and only one hypertrophic. The left ventricular ejection fraction assessed by radionuclide ventriculography was normal and no regional wall motion abnormality was detected in any patient by echocardiographic and scintigraphic studies. Metabolic abnormalities detected by the iodine-123-beta-methyl fatty acid analog in hypertrophic cardiomyopathy may be independent of thallium myocardial perfusion, regional wall motion, or the magnitude of cardiac hypertrophy, suggesting that fatty acid imaging may be useful in investigating the pathogenesis and subclinical abnormality of hypertrophic cardiomyopathy, and differentiation from secondary, induced cardiac hypertrophy.
利用铊和心脏代谢示踪剂15-（对碘苯基）-3-R，S-甲基十五烷酸（BMIPP）进行双示踪断层扫描，对8例肥厚型心肌病（HCM）患者和3例高血压（HT）患者中与心脏肥大相关的脂肪酸代谢和灌注异常进行了研究。通过与二维超声心动图测量的左心室壁厚度比较，对143个节段（每个心脏13个）的铊和BMIPP摄取进行评分和分析。HT患者中两种评分的完全一致性显著高于HCM患者（64%对24%，p<0.001），而与铊相比BMIPP摄取较低（不匹配）在HCM患者中比HT患者更常见（65%对31%，p<0.001）。壁厚度与BMIPP摄取评分显著相关（p<0.005）。HCM患者在22个肥厚节段（59%）和15个非肥厚节段（41%）显示出低BMIPP摄取，在29%的肥厚节段中BMIPP摄取降低，而HT患者仅显示5个节段BMIPP摄取降低，其中4个为非肥厚节段，仅1个为肥厚节段。通过放射性核素心室造影评估的左心室射血分数正常，超声心动图和闪烁扫描研究在任何患者中均未检测到区域壁运动异常。碘-123-β-甲基脂肪酸类似物在肥厚型心肌病中检测到的代谢异常可能独立于铊心肌灌注、区域壁运动或心脏肥大的程度，提示脂肪酸成像可能有助于研究肥厚型心肌病的发病机制和亚临床异常，以及与继发性、诱导性心脏肥大的鉴别。
