Narita M, Kurihara T, Sindoh T, Sawada Y, Honda M
Department of Cardiology, Sumitomo Hospital.
Kaku Igaku. 1998 Apr;35(4):229-37.
We performed 123I-BMIPP (BMIPP) imaging in order to clarify the characteristics of fatty acid metabolism and its effect on prognosis in patients with congestive heart failure (CHF) without coronary artery disease. We studied 15 normal subjects and 42 patients with CHF (idiopathic dilated cardiomyopathy; 24, hypertensive heart disease; 12, valvular heart disease; 6). We obtained cardiac imaging with BMIPP and 201Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (%Uptake). We calculated the cardiac uptake ratio of BMIPP (%Uptake of BMIPP divided by %Uptake of 201Tl), percent washout of BMIPP from the heart over 3 hours and unhomogeneity of myocardial distribution of BMIPP (coefficient of variation of BMIPP, CV) as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of CHF which requiring readmission. Uptake ratio (CHF: 0.91 +/- 0.17, normal; 1.10 +/- 0.09, p = 0.0000) and CV (CHF; 20 +/- 5, normal; 16 +/- 5, p = 0.0385) were different significantly between CHF and normal subjects. During the follow-up period of 27.2 +/- 14.4 months (4.5-53.5 months) cardiac events developed in 15 patients (cardiac death; 8, deterioration of CHF; 7). In univariate analysis, %uptake of 201Tl, uptake ratio, % FS, serum norepinephrine level and serum renin activity were different significantly between event and event-free groups. Cox proportional hazard analysis showed that the uptake ratio (p = 0.0000) and age (p = 0.018) were independent predictors of cardiac events. In patients with uptake ratio less than 0.88, relative risks of cardiac events was 23.7 times greater than in patients with uptake ratio more than 0.89. These data suggested that in patients with CHF fatty acid metabolism was deteriorated and cardiac uptake of BMIPP was a strong and independent predictor of long-term prognosis in patients with heart failure.
为了阐明无冠状动脉疾病的充血性心力衰竭（CHF）患者脂肪酸代谢的特征及其对预后的影响，我们进行了123I-苄基十五烷酸（BMIPP）显像。我们研究了15名正常受试者和42例CHF患者（特发性扩张型心肌病；24例，高血压性心脏病；12例，瓣膜性心脏病；6例）。在出院前不同日期，我们让受试者静息状态下分别接受BMIPP和201Tl心肌显像。利用全身显像，计算心脏对同位素摄取量与总注射剂量的比值（%摄取率）。我们计算了BMIPP的心脏摄取率（BMIPP的%摄取率除以201Tl的%摄取率）、3小时内心脏BMIPP的清除率以及BMIPP心肌分布的不均匀性（BMIPP的变异系数，CV）作为闪烁显像参数。心脏事件定义为心脏死亡或CHF恶化需要再次入院。摄取率（CHF组：0.91±0.17，正常组：1.10±0.09，p = 0.0000）和CV（CHF组：20±5，正常组：16±5，p = 0.0385）在CHF患者和正常受试者之间有显著差异。在27.2±14.4个月（4.5 - 53.5个月）的随访期内，15例患者发生了心脏事件（心脏死亡8例，CHF恶化7例）。单因素分析显示，201Tl的%摄取率、摄取率、%FS、血清去甲肾上腺素水平和血清肾素活性在发生心脏事件组和未发生心脏事件组之间有显著差异。Cox比例风险分析表明，摄取率（p = 0.0000）和年龄（p = 0.018）是心脏事件的独立预测因素。摄取率小于0.88的患者，发生心脏事件的相对风险比摄取率大于0.89的患者高23.7倍。这些数据表明，CHF患者脂肪酸代谢受损，BMIPP的心脏摄取是心力衰竭患者长期预后的一个强有力的独立预测因素。
