Published Online
on September 26, 2005

A more recent version of this article appeared on October 4, 2005

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Submitted on December 17, 2004
Revised on May 22, 2005
Accepted on July 15, 2005

Metabolic Imaging With -Methyl-p-[¹²³I]-Iodophenyl-Pentadecanoic Acid Identifies Ischemic Memory After Demand Ischemia

Vasken Dilsizian MD^*, Timothy M. Bateman MD, Steven R. Bergmann MD, PhD, Roger Des Prez MD, Martin Y. Magram MD, Anne E. Goodbody PhD, John W. Babich PhD, and James E. Udelson MD

From the Division of Nuclear Medicine, University of Maryland Hospital and School of Medicine, Baltimore (V.D., M.Y.M.); Cardiovascular Consultants, Kansas City, Mo (T.M.B.); Cardiovascular Division, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY (S.R.B.); Oklahoma Heart Institute, Tulsa (R.D.P.); Molecular Insight Pharmaceuticals, Inc, Cambridge, Mass (A.E.G., J.W.B.); and Division of Cardiology, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, Mass (J.E.U.).

^* To whom correspondence should be addressed. E-mail: vdilsizian{at}umm.edu.

Background--After myocardial ischemia, prolonged suppression of fatty acid metabolism may persist despite restoration of blood flow, which is called metabolic stunning. We hypothesized that a branched-chain fatty acid, -methyl-p-[¹²³I]-iodophenyl-pentadecanoic acid (BMIPP), might identify the presence of myocardial ischemia late after demand ischemia at rest up to 30 hours later.

Methods and Results--In 32 patients with exercise-induced ischemia on thallium SPECT, BMIPP was injected at rest within 30 hours of ischemia. SPECT images were acquired beginning 10 minutes after injection (early) and again 30 minutes after injection (delayed). Thallium and BMIPP SPECT data were read separately by 3 observers blinded to other imaging and clinical data. Agreement between BMIPP and thallium data for the presence of an abnormality on the patient level was 91% (95% CI, 75 to 98) for the early BMIPP data and 94% (95% CI, 79 to 99) for the delayed BMIPP data. Agreement between delayed BMIPP and thallium was 95% among 21 patients studied on the same day, a mean of 6.2±1.4 hours after exercise-induced ischemia, and 91% among the 11 patients studied on the next calendar day, a mean of 24.9±2.6 hours after ischemia (P=NS). The magnitude of resting BMIPP metabolic defect by semiquantitative visual analysis was correlated to the magnitude of exercise-induced thallium perfusion defect (r=0.6, P<0.001 for early BMIPP; r=0.5, P=0.005 for delayed BMIPP).

Conclusions--Metabolic imaging with BMIPP identifies patients with recent exercise-induced myocardial ischemia. These findings support the concept that BMIPP imaging can successfully demonstrate the metabolic imprint of a stress-induced ischemic episode, also known as ischemic memory.

Key words: imaging • ischemia • metabolism • nuclear medicine • radioisotopes

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