technetium-tc-99m-tetrofosmin and iodofiltic-acid

(18)F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) is assumed to be the most useful method for evaluating the viability of the myocardium. However, there are few reports regarding serial changes in (18)F-FDG-PET images of acute myocardial infarction (AMI). We evaluated serial changes in glucose-loaded (18)F-FDG-PET, (123)I-β-methyl-p-iodophenyl-penta-decanoic acid (BMIPP) single-photon emission computed tomography (SPECT) and (99m)Tc-Tetrofosmin (TF) gated SPECT images in patients with AMI.. We enrolled 7 consecutive patients with first anterior AMI who successfully underwent percutaneous coronary intervention (PCI). (18)F-FDG-PET images were obtained in the acute, subacute, chronic, mid-term and long-term phases. (123)I-BMIPP and (99m)Tc-TF SPECT images were obtained in the subacute, chronic, mid-term and long-term phases. We determined the total defect score (TDS) for each image. The TDS of the glucose-loaded (18)F-FDG-PET, (123)I-BMIPP and( 99m)Tc-TF SPECT images indicated significant serial decrease (P<0.001). Comparing these images, the TDS of the glucose-loaded (18)F-FDG-PET images was larger than that of the (123)I-BMIPP and (99m)Tc-TF SPECT images, and the TDS indicated (18)F-FDG-PET>(123)I-BMIPP>(99m)Tc-TF in all phases.. The defect areas of glucose-loaded (18)F-FDG-PET images were significantly larger than those of (123)I-BMIPP and( 99m)Tc-TF SPECT images during 9 months follow-up of patients with successful PCI for anterior AMI. Additionally, the impairment of glucose metabolism was prolonged.

Topics: Aged; Fatty Acids; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Percutaneous Coronary Intervention; Positron-Emission Tomography; Radiography; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

(18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) is assumed to be the most useful method of evaluating the viability of the myocardium, but its use is limited by the need for a cyclotron. In the present study, the ability of a combination of (99m)Tc-tetrofosmin (TF) and (123)I-beta-methyliodophenyl pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT), a combination of (18)F-FDG PET and (123)I-BMIPP SPECT, and a combination of (18)F-FDG PET and (99m)Tc-TF SPECT were compared to predict functional improvement of ischemic myocardium after a large acute myocardial infarction (AMI).. Ten patients with large AMI were studied by (99m)Tc-TF SPECT, (123)I-BMIPP SPECT and (18)F-FDG PET within 3 weeks. Six months later, (99m)Tc-TF imaging was performed. All patients underwent successful revascularization, and had no restenosis. Regional tracer uptake was scored using a 4-point scale in 20 segments of the SPECT and PET images. When the defect score of (123)I-BMIPP SPECT exceeded the defect score of (99m)Tc-TF SPECT or (18)F-FDG PET by 1 point or more, and when the defect score of (99m)Tc-TF SPECT exceeded the defect score of (18)F-FDG PET by 1 point or more, the segment was considered to show mismatching. When the defect score was the same in 2 tracers, the segment was considered to show matching. (99m)Tc-TF imaging at 3 weeks and 6 months used quantitative gated SPECT (QGS) to score wall motion using a 6-point scale (-1= dyskinesis, 0= akinesis, 1= severe hypokinesis, 2= moderate hypokinesis, 3= mild hypokinesis, and 4= normokinesis). The sensitivity of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 61%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 94%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 76%. The specificity of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 83%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 40%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 49%. The accuracy of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 70%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 71%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 63%.. The combination of (123)I-BMIPP and (99m)Tc-TF imaging is a practical modality for predicting the functional improvement of ischemic myocardium after a large AMI.

Topics: Aged; Drug Combinations; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Myocardial Revascularization; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

We compared Takotsubo cardiomyopathy (transient left ventricular apical ballooning) with acute myocardial infarction (AMI) using two-dimensional echocardiography, 99mTc-tetrofosmin, 99mTc-PYP, 123I-BMIPP and 123I-MIBG myocardial SPECT.. We examined 7 patients with Takotsubo cardiomyopathy and 7 with AMI at the time of emergency admission (acute phase), and 2-14 days (subacute phase), one month (chronic phase), and 3 months (chronic II phase) after the attack. The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored according to five grades from normal (0) to severely abnormal (4).. Coronary angiography showed the absence of stenotic regions in patients with Takotsubo cardiomyopathy, and severely stenotic and/or occlusive lesions in patients with AMI. The total ST segment elevation on electrocardiograms (mm) was 7.8 +/- 3.7 in those with Takotsubo cardiomyopathy, and 7.3 +/- 3.9 in patients with AMI. Abnormal wall motion scores on echocardiograms were 14.2 +/- 4.6, 4.7 +/- 4.0, 1.7 +/- 2.0 and 0.5 +/- 0.4 during the acute, subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 14.0 +/- 4.3, 11.4 +/- 3.9, 8.8 +/- 3.6 and 5.2 +/- 4.8 in those with AMI. Abnormal myocardial perfusion scores on 99mTc-tetrofosmin images were 11.8 +/- 3.5, 3.2 +/- 3.0, 0.5 +/- 1.2 and 0.2 +/- 0.4 during the acute, subacute, chronic and chronic II phases, in patients with Takotsubo cardiomyopathy, and 16.2 +/- 4.3, 13.9 +/- 4.6, 7.9 +/- 4.6 and 5.0 +/- 4.5, respectively, in those with AMI. Abnormal myocardial fatty acid scores on 123I-BMIPP images were 12.6 +/- 3.7, 6.8 +/- 3.2 and 0.4 +/- 0.6 during the subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 16.5 +/- 5.1, 14.7 +/- 4.8 and 7.5 +/- 4.5 in those with AMI. Abnormal myocardial sympathetic nerve function scores on 123I-MIBG images were 14.8 +/- 4.0, 8.8 +/- 4.0 and 0.4 +/- 0.6 during the subacute, chronic, chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 18.6 +/- 6.5, 16.8 +/- 6.8 and 12.9 +/- 5.2 in those with AMI. Myocardial 99mTc-PYP uptake was abnormal not only in patients with AMI but also in those with Takotsubo cardiomyopathy during the acute phase.. Takotsubo cardiomyopathy might represent a stunned myocardium caused by a disturbance of the coronary microcirculation.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Cardiomyopathies; Diagnosis, Differential; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Syndrome; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

Basic and clinical studies have indicated that 15-(p-[(123)I] iodophenyl)-3-(R, S) methylpentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) can identify ischemic myocardium without evidence of myocardial infarction by the regional decline of tracer uptake. The present study compared BMIPP SPECT with rest-stress myocardial perfusion imaging (MPI) findings and coronary angiography (CAG) in 150 patients with acute chest pain.. Patients with acute chest pain who underwent all of the following tests were selected: MPI at rest-stress, BMIPP SPECT at rest and CAG. Organic coronary artery stenosis (>or=75%) was observed in 46 patients, 27 patients had total or subtotal coronary occlusion by spasm in the spasm provocation test on CAG and the remaining 77 patients had no significant coronary artery stenosis or spasm. The sensitivity of BMIPP at rest to detect organic stenosis was significantly higher (54%) than that of rest-MPI (33%, p<0.005), but lower than that of stress-MPI (76%, p=0.05). The sensitivity of BMIPP at rest to detect spasm was significantly higher (63%) than that of both rest-MPI (15%; p<0.001) and stress-MPI (19%; p<0.001). Overall, the sensitivity of BMIPP at rest to detect both organic stenosis and spasm was significantly higher (58%) than that of rest-MPI (26%; p<0.001), despite having no significance with that of stress-MPI (55%). The specificity was not significantly different among the three imaging techniques.. Resting BMIPP SPECT is an alternative method to stress MPI for identifying patients with not only organic stenosis but also spasm without the need for a stress examination.

Topics: Aged; Chest Pain; Coronary Angiography; Coronary Artery Disease; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

123I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) and 99mTc-tetrofosmin (TET) are widely used for evaluation of myocardial fatty acid metabolism and perfusion, respectively. ECG-gated TET SPECT is also used for evaluation of myocardial wall motion. These tests are often performed on the same day to minimize both the time required and inconvenience to patients and medical staff. However, as 123I and 99mTc have similar emission energies (159 keV and 140 keV, respectively), it is necessary to consider not only scattered photons, but also primary photons of each radionuclide detected in the wrong window (cross-talk). In this study, we developed and evaluated the effectiveness of a new scatter and cross-talk correction imaging protocol.. Fourteen patients with ischemic heart disease or heart failure (8 men and 6 women with a mean age of 69.4 yr, ranging from 45 to 94 yr) were enrolled in this study. In the routine one-day acquisition protocol, BMIPP SPECT was performed in the morning, with TET SPECT performed 4 h later. An additional SPECT was performed just before injection of TET with the energy window for 99mTc. These data correspond to the scatter and cross-talk factor of the next TET SPECT. The correction was performed by subtraction of the scatter and cross-talk factor from TET SPECT. Data are presented as means +/- S.E. Statistical analyses were performed using Wilcoxon's matched-pairs signed-ranks test, and p < 0.05 was considered significant.. The percentage of scatter and cross-talk relative to the corrected total count was 26.0 +/- 5.3%. EDV and ESV after correction were significantly greater than those before correction (p = 0.019 and 0.016, respectively). After correction, EF was smaller than that before correction, but the difference was not significant. Perfusion scores (17 segments per heart) were significantly lower after as compared with those before correction (p < 0.001).. Scatter and cross-talk correction revealed significant differences in EDV, ESV, and perfusion scores. These observations indicate that scatter and cross-talk correction is required for one-day acquisition of 123I-BMIPP and 99mTc-tetrofosmin SPECT.

Topics: Aged; Aged, 80 and over; Artifacts; Fatty Acids; Female; Heart Failure; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Phantoms, Imaging; Radiopharmaceuticals; Reproducibility of Results; Scattering, Radiation; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

The diagnostic value of technetium-99m tetrofosmin (TF) washout in hypertrophic cardiomyopathy (HCM) was examined by investigating its relation to the metabolic abnormality depicted by iodine-123 beta-methyl- p-iodophenylpentadecanoic acid (BMIPP) uptake and the left ventricular (LV) myocardial wall thickness as measured by magnetic resonance imaging (MRI). TF washout was evaluated in 31 patients with HCM and 23 normal control subjects using 30-min (early) and 3-h (delayed) TF single-photon emission tomography images. The LV myocardial wall was divided into 19 segments and the percentage TF washout, regional BMIPP uptake and LV wall thickness were measured in each segment. Mean TF washout in the patients with HCM was significantly faster than that in normal control subjects (23.7+/-5.7 vs 13.4+/-4.1, P<0.0001). In the patients with HCM, TF washout showed an excellent correlation with MRI wall thickness ( r=0.82, P<0.0001) and a good inverse correlation with regional BMIPP uptake ( r=-0.72, P<0.0001). In addition, a good linear correlation was observed between TF uptake and MRI wall thickness in the 19 regional segments. In conclusion, the degree of TF washout corresponds well with the severity of myocardial wall thickness and the degree of metabolic abnormality in patients with HCM. These results suggest that enhanced TF washout might provide additional clinical information regarding metabolic alterations in HCM.

Topics: Adult; Cardiomyopathy, Hypertrophic; Fatty Acids; Heart Ventricles; Humans; Iodobenzenes; Magnetic Resonance Imaging; Male; Metabolic Clearance Rate; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Ventricular Dysfunction, Left

To investigate myocardial fatty acid metabolism and its relationship with left ventricular (LV) function and perfusion in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM).. Thirty-nine patients with cardiomyopathies (58 +/- 14 y), comprising 15 DCM and 24 HCM, and 9 age-matched healthy controls were studied with 123I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) and 99mTc-tetrofosmin (TF) electrocardiographically gated SPECT. As parameters of myocardial fatty acid metabolism, the heart-to-mediastinum ratio (H/M) and global washout of BMIPP were calculated from early and delayed planar images, while regional BMIPP uptake and washout were calculated from SPECT. In TF study, the H/M (H/M-TF) and LV ejection fraction (LVEF) were calculated as global parameters of perfusion and function, while regional TF uptake and wall thickening index were calculated as regional parameters of perfusion and function using the Quantitative Gated SPECT software. The differences in the parameters and the correlations between the parameters from the 2 studies were investigated by one-way ANOVA and multiple linear regression analysis.. BMIPP uptake was decreased (p < 0.05), and its washout was increased (p < 0.05) in DCM and HCM. In multiple linear regression analysis, global BMIPP parameters showed no significant correlation with LVEF (p > 0.05), but showed a significant correlation with H/M-TF (p < 0.05) in DCM and HCM. According to the partial correlation coefficient, early H/M was the only significant factor (p < 0.05) for predicting H/M-TF in DCM and HCM. Multiple linear regression analysis on regional parameters showed regional BMIPP parameters had no correlation with regional function (p > 0.05) but had a significant correlation with regional perfusion (p < 0.0001) in DCM. In HCM, regional BMIPP parameters showed significant multiple linear correlations with both regional function (p < 0.005) and perfusion (p < 0.0001). According to the partial correlation coefficients, delayed regional BMIPP uptake was the most significant factor for predicting regional function in HCM, while early regional BMIPP uptake was the only or the most significant factor for predicting regional perfusion in DCM and HCM, respectively.. In DCM, BMIPP uptake and washout could not reflect LV function. In HCM, regional delayed BMIPP uptake might be useful for evaluating regional function. In DCM and HCM, early BMIPP uptake might be largely determined by myocardial perfusion.

Topics: Adolescent; Adult; Aged; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Electrocardiography; Fatty Acids; Female; Gated Blood-Pool Imaging; Heart Ventricles; Humans; Iodobenzenes; Male; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Ventricular Dysfunction, Left

Previous studies have indicated that iodine-123 labelled beta-methyliodophenyl pentadecanoic acid (BMIPP), an iodinated fatty acid analogue, can identify persistent alteration of fatty acid metabolism after restoration of blood flow. To assess whether fatty acid imaging can delineate areas at risk following successful revascularization in patients with acute myocardial infarction (AMI), BMIPP findings at 1 week post AMI were compared with perfusion imaging before and after revascularization therapy. Sixty-five patients with AMI underwent technetium-99m tetrofosmin single-photon emission tomography (SPET) before m (TF0) and 1 week (TF1) after successful revascularization therapy. BMIPP SPET was also performed under a fasting state at 1 week (BM1) post AMI. The extent scores were calculated from the defect scores in 20 segments. The BM1 score (7.7 +/- 3.9) was similar to the TF0 score (8.8 +/- 4.2) (r = 0.86, P < 0.0001), but significantly higher than the TF1 score (5.8 +/- 3.9) (P < 0.0001). A significant correlation was observed between the BM1 score and TF0 score (r = 0.86, P < 0.0001). Among a total of 1300 segments, the BM1 score was identical to the TF0 score in 1156 (88.9%). These data indicate that the ability of BMIPP imaging at 1 week post AMI to identify areas at risk is similar to that of tetrofosmin perfusion imaging in the acute phase. This may be due to the impairment of fatty acid uptake and metabolism reflecting prior severe ischaemic insult which persists at least 1 week after recovery of perfusion in the acute phase of AMI.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Coronary Circulation; Fatty Acids; Female; Humans; Image Processing, Computer-Assisted; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Risk Assessment; Tomography, Emission-Computed, Single-Photon

Topics: Cadmium; Fatty Acids; Feasibility Studies; Humans; Iodine Radioisotopes; Iodobenzenes; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Tellurium; Zinc

The use of cadmium-zinc-telluride-based scanners may increase the clinical feasibility of simultaneous dual-isotope imaging. In the current study, we sought to investigate a potential acquisition time in simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging using a Discovery NM/CT 670 cadmium-zinc-telluride.. Simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging was performed in 29 patients who had undergone primary percutaneous coronary intervention for acute myocardial infarction. Referenced images with an acquisition time of 65 s/view (16.25 min) were reframed to produce images with acquisition times of 33, 16, and 8 s/view. The values for the quantitative-gated single-photon emission computed tomography (SPECT) and the quantitative perfusion SPECT were compared.. The quantitative-gated SPECT values for images with 33, 16, and 8 s/views showed good consistency with those for 65 s/view (the lower 95% confidence intervals for the intraclass correlation were ≥0.80). The quantitative perfusion SPECT values for Tc-tetrofosmin images with 33, 16, and 8 s/views also showed good consistency with those for 65 s/view; however, the quantitative perfusion SPECT values for I-β-methyl-p-iodophenyl pentadecanoic acid images with an acquisition time of 8 s/view were not consistent with the reference acquisition time of 65 s/view.. The quantitative-gated SPECT and quantitative perfusion SPECT values obtained from images with shorter acquisition times correlated with the values obtained from images with a reference acquisition time of 65 s/view; however, tracer-specific predisposition should be considered. These findings suggest that it is possible to reduce acquisition time when performing simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-tracer imaging with the novel cadmium-zinc-telluride scanner.

Topics: Acute Disease; Cadmium; Fatty Acids; Female; Humans; Image Processing, Computer-Assisted; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Percutaneous Coronary Intervention; Tellurium; Time Factors; Tomography, Emission-Computed, Single-Photon; Zinc

Myocardial fibrosis is considered to be an important factor in myocardial dysfunction and sudden cardiac death in hypertrophic cardiomyopathy (HCM). The purpose of this study was to compare myocardial fibrosis detected by late gadolinium enhancement (LGE) on cardiac MRI with myocardial perfusion and fatty acid metabolism assessed by single photon emission computed tomography in HCM.. We retrospectively evaluated 20 consecutive HCM patients (female, 7; mean age, 53.4 years) who underwent LGE, technetium-99m methoxyisobutylisonitrile/tetrofosmin (99mTc-MIBI/tetrofosmin), and iodine-123 beta-methyl-iodophenylpentadecanoic acid (123I-BMIPP) imaging. We calculated the myocardium-to-lumen signal ratio (M/L) for LGE in 17 segments based on the American Heart Association statement. Scoring of 99mTc-MIBI/tetrofosmin (PI) and 123I-BMIPP (BM) was performed for each segment using a 5-point scale (0, normal; 4, highly decreased).. Nineteen of 20 patients (95%) and 153 of 340 segments (45%) showed LGE. M/Ls were 0.42±0.16, 0.55±0.17, and 0.65±0.24 in PI0/BM0, PI0/BM1-4 and PI1-4/BM1-4, respectively. All M/Ls were significantly higher than that of a normal control (0.34±0.14) (p<0.001).. Myocardial fibrosis in HCM can occur despite normal perfusion and fatty acid metabolism, and is more strongly associated with disorders of fatty acid metabolism than with perfusion abnormalities. M/L may be a useful indicator of disease severity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cardiomyopathy, Hypertrophic; Fatty Acids; Female; Fibrosis; Gadolinium DTPA; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Retrospective Studies; Tomography, Emission-Computed, Single-Photon

(123)I-beta-methyl-iodophenyl pentadecanoic acid (BMIPP) and (99m)Tc-Tetrofosmin (TF) mismatch designated as stunned myocardium having both systolic and diastolic components. The degree of mismatch might reflect subsequent functional improvement, and this study was designed to unravel the impact of mismatched defect score (MMDS) on recovery of both systolic and diastolic function following acute myocardial infarction (AMI). Forty patients with recent AMI were recruited, and all of them underwent emergency percutaneous coronary intervention. Echocardiography and BMIPP and TF cardiac scintigraphy were performed on 7 +/- 3 days of admission. Follow up echocardiography was performed after 3 months. MMDS were compared with the systolic [ejection fraction (EF) and wall motion score index (WMSI)] and diastolic [peak velocity of early diastolic filling of mitral inflow/peak early diastolic velocity of the mitral annulus(E/E') and left atrial volume index(LAVI)] parameters. BMIPP defect score was significantly higher than the TF defect score and there was a strong positive correlation between them (r = 0.90, P < 0.00001). Thirty-two (80%) patients showed mismatched defect and rest 8(20%) showed matched defect. Of 32 patients 24(75%), 22(69%), 19(59%), and 20(62.5%) showed improved EF, WMSI, E/E' and LAVI respectively. Conversely out of 8 only 2(25%), 1(12.5%), and 2(25%) patients showed improvement of EF, WMSI and LAVI, respectively. E/E' was not improved in patients with matched defect. MMDS were significantly correlated with the improvement of EF (r = -0.46, P = 0.002), WMSI (r = 0.41, P = 0.007), E/E' (r = 0.56, P < 0.0002), and LAVI (r = 0.44, P = 0.004). Mismatched defect score could predict the approximate amount of viable dysfunctional myocardium, and the degree of mismatch showed a significant correlation with the improvement of both systolic and diastolic function.

Topics: Aged; Angioplasty, Balloon, Coronary; Cross-Sectional Studies; Echocardiography, Doppler; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Perfusion Imaging; Myocardial Stunning; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Recovery of Function; Stroke Volume; Time Factors; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left

In 2008, 1,007 cases of suicide in which hydrogen sulfide was used as a suicidal agent were reported in Japan, and this has become a serious social problem. Here, we report the successful revival of a patient suffering from a severe disturbance of consciousness and respiratory failure caused by hydrogen sulfide poisoning; further, his condition was complicated by myocardial infarction. This is an important case where we examined the tendency toward improvement in myocardial damage in a patient in the acute phase of severe hydrogen sulfide poisoning who was treated for approximately 6 months.

Topics: 3-Iodobenzylguanidine; Adult; Echocardiography; Electrocardiography; Fatty Acids; Heart Failure; Humans; Hydrogen Sulfide; Iodobenzenes; Male; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Suicide, Attempted; Time Factors

Enhanced washout of 99mTc-tetrofosmin (TF) has been reported in patients with hypertrophic cardiomyopathy (HCM). Here, using quantitative dual-autoradiography, the relationship between TF retention abnormality and metabolism depicted by 125I-BMIPP uptake was investigated quantitatively in a hamster model of cardiomyopathy.. Early and delayed TF images were obtained at 5 min (7 cardiomyopathic and 5 normal hamsters) and 60 min (8 cardiomyopathic and 5 normal hamsters) after injection, respectively. BMIPP image was obtained 5 min after injection. Five cardiomyopathic and 5 normal hamsters were evaluated histologically. Percent uptake of TF and BMIPP in the heart was measured by an auto-well counter. The left ventricular wall was divided into 12 segments, and the relative regional uptake of TF and BMIPP was measured for each segment. Heterogeneity of radioactive distribution was determined by the standard deviation (SD) of radioactive counts in the left ventricular wall on autoradiogram. The uptake of early TF, delayed TF, and BMIPP in cardiomyopathic hamsters was 8.8%, 20.3%, and 25.3% lower than that in normal hamsters, p < 0.05, p < 0.01, and p < 0.001, respectively. In normal hamsters, distribution of radioactivity in all images was homogeneous, and the SD values were about 13. In cardiomyopathic hamsters, heterogeneous distribution was observed on all images, and the degree of heterogeneity was marked on delayed TF and BMIPP images. The SD was 19.7 +/- 1.2 for early TF image, 25.5 +/- 1.4 for delayed TF image, and 31.7 +/- 2.4 for BMIPP image, respectively. A weak linear correlation was observed between the relative regional uptake of the delayed TF and BMIPP in cardiomyopathic hamsters (r = 0.57). Electron microscopy demonstrated ultra-structural changes in mitochondria of cardiomyopathic hamsters.. Degree of retention abnormality on delayed TF image corresponded to the metabolic abnormality, probably due to mitochondrial dysfunction, depicted on BMIPP imaging.

Topics: Animals; Autoradiography; Cardiomyopathies; Cricetinae; Disease Models, Animal; Fatty Acids; Heart Ventricles; Image Interpretation, Computer-Assisted; Iodine Radioisotopes; Iodobenzenes; Mesocricetus; Metabolic Clearance Rate; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Tissue Distribution

A 72-year-old woman had insidious onset of heart failure, and was diagnosed as multicentric Castleman's disease. She underwent myocardial imaging with technetium-99m tetrofosmin, 1-123 beta-methyl-iodophenyl pentadecanoic acid (BMIPP). Technetium-99m tetrofosmin studies showed almost normal uptake of the left ventricular myocardium indicating normal myocardial perfusion. 1-123 BMIPP showed reduced uptake in the apical segment of the myocardium, indicating regional fatty acid metabolic abnormalities.

Topics: Aged; Castleman Disease; Fatty Acids; Female; Heart Failure; Humans; Iodobenzenes; Metabolic Diseases; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Technetium; Tomography, Emission-Computed, Single-Photon

A 69-year-old woman presented with dyspnea on exertion. Echocardiography showed dilatation and diffuse hypokinesis of the left ventricle. 99mTc-tetrofosmin myocardial SPECT showed moderately reduced uptake in the anteroseptal wall and the inferior wall on the rest images, but was improved on the ATP loading images. 123I-BMIPP myocardial SPECT showed severely reduced uptake in the anterior wall and the inferior wall. These SPECT findings suggested ischemic heart disease rather than dilated cardiomyopathy. Coronary angiography showed no organic stenosis, but diffuse coronary ectasia was noted in three vessels. Intravascular ultrasound revealed remarkable coronary ectasia, with a maximal diameter of 8.2 mm. Coronary flow velocity as measured by Doppler blood flow guide wire was remarkably reduced. Coronary spasms were not provocated by ergonovine loading test. These findings suggested that microvascular thrombi and disturbance of dilatation caused myocardial ischemia in this patient. We treated the patient with ticlopidine and nicorandil. Following treatment left ventricle wall motion, 99mTc-tetrofosmin and 123I-BMIPP myocardial SPECT findings were improved.

Topics: Aged; Coronary Disease; Coronary Vessels; Dilatation, Pathologic; Fatty Acids; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Microcirculation; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

A 57-year-old woman was emergently admitted to our hospital because of chest oppression. On examination, blood pressure was 174/96 mmHg, pulse rate was 90/min and coarse crackle and third heart sound were audible. On laboratory data, the levels of LDH and CPK-MB were mildly elevated. Electrocardiogram (ECG) demonstrated elevation of the ST segment in leads I, aVL and V2-V5. 99mTc-tetrofosmin myocardial SPECT (TF) showed severely reduced uptake in the apex and anterior wall. Emergent coronary angiography (CAG) did not show any stenotic lesion. Left ventriculography (LVG), however, demonstrated akinesis of the apex, anterior, and inferior walls, and basal hyperkinesis. On the second hospital day, ECG demonstrated inverted T wave in leads I, aVL and V2-V5. 123I-BMIPP myocardial SPECT (BMIPP) and 123I-MIBG myocardial SPECT (MIBG) were performed on the second and fourth hospital days, respectively. These cardiac images showed severely reduced uptake equally. TF, BMIPP, and MIBG were re-examined on the eighth, tenth, and twelfth hospital days, respectively. MIBG, BMIPP, and TF showed reduced uptake in order of severity. On the fourteenth hospital day, CAG and LVG were re-examined. Coronary vasospasm provocation test was negative using ergonovine and acetylcholine, and LVG did not demonstrated any sign of asynergy. We considered that this case was "Takotsubo" cardiomyopathy and might be caused by microvascular spasm.

Topics: 3-Iodobenzylguanidine; Acute-Phase Reaction; Cardiomyopathies; Coronary Vasospasm; Fatty Acids; Female; Gated Blood-Pool Imaging; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Microcirculation; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

This patient was a 70-year-old man had acute subendocardial infarction in the inferior wall. 123I-BMIPP myocardial scintigraphy showed no accumulation in the myocardium. 123I-MIBG myocardial scintigraphy on the early and delay images and 99mTc-tetrofosmin myocardial scintigraphy at rest showed slightly decreased accumulation of the tracer in the apical region and in middle inferior wall of the left ventricle, indicating subendocardial infracted area. In the examinations of CD36 in platelets and monocytes, the patient had negative CD36 in platelets and monocytes, and type I CD36 deficiency was diagnosed. We supposed that no 123I-BMIPP accumulation may be related closely to type I CD36 deficiency.

Topics: 3-Iodobenzylguanidine; Aged; CD36 Antigens; Endocardium; Fatty Acids; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Myocardial Infarction; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals

Myocardial perfusion imaging with 99mTc-labeled agents immediately after reperfusion therapy can underestimate myocardial salvage. It is also conceivable that delayed imaging is useful for assessing the risk area. However, to our knowledge, very few studies have sequentially evaluated these image changes. We conducted 99mTc-tetrofosmin (TF) and 123I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) SPECT before and after reperfusion to treat acute myocardial infarction and quantified changes in TF myocardial accumulation and reverse redistribution.. Seventeen patients with a first myocardial infarction underwent successful reperfusion. We examined SPECT images obtained at the onset (preimage), those acquired 30 min (early image) and 6 h (delayed image) after TF injection, and images acquired 1, 4, 7, and 20 d after reperfusion (post-1-d, post-4-d, post-7-d, and post-20-d image, respectively). We also examined BMIPP SPECT images after 7 +/- 1.8 d (BMIPP image). Polar maps were divided into 48 segments to calculate percentage uptake, and time course changes in segment numbers below 60% were observed as abnormal area. Moreover, cardiac function was analyzed by gated TF SPECT on 1 and 20 d after reperfusion.. In reference to the abnormal area on the early images, the post-1-d image was significantly improved compared with the preimage (P < 0.01) as was the post-7-d image compared with the post-1-d and post-4-d images (P < 0.05, respectively). However, post-20-d and post-7-d images did not significantly differ. Therefore, the improvement in myocardial accumulation reached a plateau 7 d after reperfusion. On the other hand, the abnormal area on the delayed images was significantly greater (P < 0.01) compared with that on the early images from 4 to 20 d after reperfusion, as the value was essentially constant. The correlations of the abnormal area between the preimage and the post-7-d delayed image, the preimage and the BMIPP image, and the post-7-d delayed image and the BMIPP image were very close (r = 0.963, r = 0.981, and r = 0.975, respectively). Gated TF SPECT revealed that the left ventricular ejection fraction was not significantly different (P = not significant) between 1 and 20 d after reperfusion, but regional wall motion was significantly different after reperfusion (P < 0.05).. These results suggest that the interval between reperfusion therapy and TF SPECT should be 7 d to evaluate the salvage effect and that TF delayed and BMIPP images are both useful in estimation of risk area.

Topics: Aged; Angioplasty, Balloon, Coronary; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Time Factors; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

The chronological changes or mechanisms in cardiac fatty acid metabolism under clinical conditions of hypoxia and ischemia have not been fully elucidated. 123-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) can be used with single photon emission computed tomography (SPECT) to evaluate myocardial fatty acid metabolism. We investigated chronological changes in energy metabolism in the stunned human myocardium by means of 123I-BMIPP myocardial SPECT.. We conducted 123I-BMIPP myocardial SPECT in 10 patients with stunned myocardium during the acute, subacute and chronic phases after onset. The left ventricle was divided into 9 regions on SPECT, and the degree of abnormalities in each region was scored in four grades from normal (0) to defect (4). We also examined wash-out rates on BMIPP images. The scores on early BMIPP images in the acute, subacute and chronic phases were 5.6 +/- 1.8, 13.4 +/- 3.5 and 2.5 +/- 1.1, respectively, and the score was highest in the subacute phase (p < 0.001). Similarly, scores on the late images were 2.3 +/- 1.7, 18.3 +/- 4.5 and 4.7 +/- 2.6, respectively, and highest in the subacute phase (p < 0.001). The wash-out rates (normal: 18.2 +/- 2.1%) in the acute, subacute and chronic phases were 12.1 +/- 4.8%, 44.9 +/- 10.0% and 23.1 +/- 4.6%, respectively, with the value being lowest during the acute phase (p < 0.05), and highest during the subacute phase (p < 0.001).. These results suggested that fatty acid metabolism in the stunned human myocardium changes dynamically over time.

Topics: Aged; Echocardiography; Energy Metabolism; Fatty Acids; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Stunning; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Time Factors; Tomography, Emission-Computed, Single-Photon

To assess whether 15-(p-[iodine-123] iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) imaging can identify previous ischemic areas, BMIPP SPECT was performed in patients with acute chest pain to compare its findings with those of technetium-99m-tetrofosmin (tetrofosmin) SPECT and coronary angiography.. Basic studies indicate that BMIPP can identify previous ischemia as reduced tracer uptake.. This study prospectively enrolled 111 consecutive patients with acute chest pain without myocardial infarction. Tetrofosmin SPECT was performed at rest within 24 h after the last episode of chest pain. Coronary angiography and BMIPP SPECT were also performed on the following day.. Sixty-four of the 87 patients with coronary stenosis or spasm showed BMIPP abnormalities corresponding to the areas of coronary abnormalities (sensitivity 74%), whereas only 33 of them showed perfusion abnormalities (sensitivity 38%) (p < 0.001). Of 24 patients [corrected] without coronary stenosis or spasm, 22 showed normal BMIPP SPECT (specificity = 92%) [corrected] and 23 showed normal tetrofosmin SPECT (sensitivity = 96%) [corrected]. Coronary stenosis was more often seen in the group with abnormal tetrofosmin/abnormal BMIPP (82%) and with normal tetrofosmin/abnormal BMIPP (69%) than in the group with normal tetrofosmin/normal BMIPP (36%) (p < 0.05). Coronary spasm was observed more often in the group with abnormal tetrofosmin/abnormal BMIPP (83%) and with normal tetrofosmin/abnormal BMIPP (90%) than in the group with normal tetrofosmin/normal BMIPP (27%) (p < 0.05). The extent and severity scores of tetrofosmin and BMIPP in the patients with organic stenosis were significantly higher than those of patients with no organic stenosis or spasm (p < 0.0001).. These data indicate that BMIPP SPECT may specifically identify previous ischemic lesions due to coronary stenosis or spasm in patients with acute chest pain.

Topics: Aged; Angina Pectoris; Chest Pain; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Diagnosis, Differential; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Tomography, Emission-Computed, Single-Photon

Electrocardiographically (ECG) gated myocardial SPECT with (99m)Tc-tetrofosmin has been used widely to assess left ventricular (LV) function. However, the accuracy of variables using ECG gated myocardial SPECT with beta-methyl-p-(123)I-iodophenylpentadecanoic acid (BMIPP) has not been well defined.. Thirty-six patients (29 men, 7 women; mean age, 61.6 +/- 15.6 y) with ischemic heart disease underwent ECG gated myocardial SPECT with (123)I-BMIPP and with (99m)Tc-tetrofosmin and left ventriculography (LVG) within 1 wk. LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV) were determined on gated SPECT using commercially available software for automatic data analysis. These volume-related items on LVG were calculated with an area-length method and were estimated by 2 independent observers to evaluate interobserver validity. The regional wall motion with these methods was assessed visually.. LVEF was 41.1% +/- 12.5% on gated SPECT with (123)I-BMIPP, 44.5% +/- 13.1% on gated SPECT with (99m)Tc-tetrofosmin, and 46.0% +/- 12.7% on LVG. Global LV function and regional wall motion between both gated SPECT procedures had excellent correlation (LVEF, r = 0.943; LVEDV, r = 0.934; LVESV, r = 0.952; regional wall motion, kappa = 0.92). However, the correlations of global LV function and regional wall motion between each gated SPECT and LVG were significantly lower. Gated SPECT with (123)I-BMIPP showed the same interobserver validity as gated SPECT with (99m)Tc-tetrofosmin.. Gated SPECT with (123)I-BMIPP provides high accuracy with regard to LV function and is sufficiently applicable for use in clinical SPECT. This technique can simultaneously reveal myocardial fatty acid metabolism and LV function, which may be useful to evaluate various cardiac diseases.

Topics: Electrocardiography; Fatty Acids; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Linear Models; Male; Middle Aged; Myocardial Contraction; Myocardial Ischemia; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

Topics: Fatty Acids; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Iodobenzenes; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

The relationship between myocardial perfusion, fatty acid metabolism, and cardiac functional recovery were investigated by using single photon emission computed tomography (SPECT) with 99mTc-1,2-bis[bis(2-ethoxyethyl)phosphino]ethane (tetrofosmin: TF) and lodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) in patients with myocardial infarction. We examined myocardial SPECT in 18 patients with acute myocardial infarction (AMI) underwent successful reperfusion therapy within 24 hours from onset. TF myocardial SPECT (early and delayed images) and BMIPP (early image) SPECT were performed 2 weeks after onset of AMI, and regional TF and BMIPP defect scores of the infarct area were scored visually by a 4-point system. There was a significant correlation between the defect score of the TF delayed image, BMIPP image and SD/chord (indicator of regional wall motion abnormalities on left ventriculograms) at subacute phase (TF: r = -0.592, p = 0.011, BMIPP: r = -0.643, p = 0.004). Good correlations were also found between the defect score of the TF delayed image, the BMIPP image and the SD/chord at chronic phase (TF: r = -0.491, p = 0.037, BMIPP: r = -0.599, p = 0.007). Furthermore, there was a significant correlation between the improvement of SD/chord (acute to chronic phase) and the degree of reverse redistribution score of TF (r = 0.735, p = 0.022), and discordance score between TF and BMIPP (r = 0.691, p = 0.037). In conclusion, resting BMIPP and TF myocardial SPECT performed in patients with subacute phase AMI were shown to be useful in predicting improvement of left ventricular function at chronic phase.

Topics: Aged; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

A 55-yr-old man underwent surgery. Soon after the procedure was finished, the patient complained of chest pain, and the electrocardiogram showed increase in the ST-segment in some leads. Emergency angiography showed normal coronary arteries, but there was asynergy in the left ventricle, and delayed filling of contrast medium was observed in the LCA. An intracoronary infusion of isosorbide dinitrate did not improve the delayed filling of contrast medium or ST segment increase in the electrocardiogram. Soon after nicorandil was injected into the LCA, the patient's symptoms, electrocardiogram, and delayed filling of contrast medium dramatically improved. On the second day, initial imaging by 123I-BMIPP myocardial SPECT showed a moderate increase in tracer uptake in the apico-anteroseptal region and a moderate decrease in tracer uptake in the lateral region, in which the first left ventriculography showed akinesis, and delayed imaging revealed a moderate increase in tracer uptake in the apical region and a high washout of 123I-BMIPP in the anteroseptal and lateral regions. On the sixth day, initial imaging by 123I-BMIPP myocardial SPECT showed a moderate decrease in tracer uptake in the apical and lateral regions and a mild decrease in tracer uptake in the anteroseptal region, and delayed imaging revealed a moderate increase in tracer uptake in the apical region and a high washout of 123I-BMIPP in the anteroseptal and lateral regions. By the 30th day, 123I-BMIPP myocardial SPECT had normalized. We consider that these dynamic changes in 123I-BMIPP myocardial SPECT imaging may reflect metabolic changes in fatty acids in the ischemic state, the size of the triacylglycerol pool, and the degree of turnover in the triacylglycerol pool.

Topics: Coronary Vasospasm; Electrocardiography; Fatty Acids; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Stunning; Organophosphorus Compounds; Organotechnetium Compounds; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Triglycerides

Unexpected breast uptake was observed in a 32-year-old woman referred for evaluation of hypertrophic cardiomyopathy. Diffuse and marked bilateral breast uptake of 123I-BMIPP and 99mTc-TF was shown by both planar and SPECT imaging during the first study, and the uptake of both radionuclides had decreased significantly eleven months later. At the time of the first radionuclide examination, she was occasionally breast feeding her 2-year-old child and had small amounts of milk production. At the follow up examination, the frequency of breast feeding was significantly reduced and she produced only small amounts of milk. Therefore, the uptake of 123I-BMIPP and 99mTc-TF may have been caused by lactation.

Topics: Adult; Breast; Cardiomyopathy, Hypertrophic; Child, Preschool; Fatty Acids; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Lactation; Organophosphorus Compounds; Organotechnetium Compounds; Tomography, Emission-Computed, Single-Photon

Working group of cardiac nuclear medicine was made as a Japanese part of society of international cardiac nuclear medicine under the cooperation between Japanese society of nuclear medicine and Japanese society of cardiology. We investigated typical normal cases and normal cases with abnormal image pattern in every myocardial SPECT radiopharmaceutical as one of the research activity of working group. From 11 faculties, 16 T1 cases, 14 BMIPP cases, 8 MIBG cases, 8 MIBI cases and 14 tetrofosmin cases were submitted as typical normal cases, and 12 T1 cases, 5 BMIPP cases, 12 MIBG cases, 10 MIBI cases and 5 tetrofosmin cases were submitted as normal cases with abnormal image pattern. We summarized the condition of SPECT data acquisition of each faculties. And we added the discussion from literature about how to discriminate normal cases with abnormal image pattern from abnormal cases. In MIBG, patterns of typical normal cases and normal cases with abnormal image pattern were slightly different from other 4 pharmaceuticals. In other 4 pharmaceuticals, diaphragmatic attenuation, breast attenuation, apical thinning and others were presented as normal cases with abnormal image pattern.

Topics: 3-Iodobenzylguanidine; Fatty Acids; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

We reported a 47-year-old female with congestive heart failure (CHF) of unknown origin. In this case, it was suggested that 123I-BMIPP and 99mTc-tetrofosmin myocardial SPECT images were useful in the diagnosis of CHF of unknown origin. She had complained of easy fatigability and dyspnea on effort since Sep. 1995. She was admitted to our hospital because of worsening of symptoms in Dec. 1995. Slightly decreased uptake in anterior, lateral and apical walls was recognized in 99mTc-tetrofosmin SPECT images, meanwhile 123I-BMIPP SPECT images showed markedly reduced uptake in the same areas. This discordance in the distribution between 123I-BMIPP and 99mTc-tetrofosmin myocardial SPECT suggested that CHF was not due to dilated cardiomyopathy, but ischemic myocardial disease. Coronary angiography revealed 90% stenosis at the just proximal of left coronary artery. This case was diagnosed an isolated coronary ostial stenosis with CHF, because she was menstruated middle aged woman and did not have a history of aortitis syndrome, syphilis and coronary risk factor before.

Topics: Coronary Disease; Fatty Acids; Female; Heart Failure; Humans; Iodine Radioisotopes; Iodobenzenes; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon