What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic heart failure (n=74). Intervention: 123I-BMIPP SPECT (H/MBMIPP:H/MTl ratio <0.75) vs. H/MBMIPP:H/MTl ratio ≥0.75. Primary outcome: Cardiac death (HR 5.57, 95% CI 1.14-27.3, p=0.034).

January 1, 2003Open Access

Clinical Value of Iodine-123 Beta-Methyliodophenyl Pentadecanoic Acid (BMIPP) Myocardial Single Photon Emission Computed Tomography for Predicting Cardiac Death Among Patients With Chronic Heart Failure

Q: What are the key findings of this study?

A cardiac uptake ratio of BMIPP to thallium (H/MBMIPP:H/MTl) less than 0.75 independently predicted cardiac death in patients with chronic heart failure (HR 5.57).

Key Result

A cardiac uptake ratio of BMIPP to thallium (H/MBMIPP:H/MTl) less than 0.75 independently predicted cardiac death in patients with chronic heart failure (HR 5.57).

Study Design

Type

Cohort (n=74)

Multicenter

Yes

Structured PICO

Does the myocardial fatty acid metabolism index (H/MBMIPP:H/MTl ratio) predict cardiac death in patients with chronic heart failure?

Population

74 patients with stable chronic heart failure and a left ventricular ejection fraction <45%, followed for a mean of 660 days.

Exposure

123I-beta-methyliodophenyl pentadecanoic acid (BMIPP) and 201Tl single photon emission computed tomography (SPECT) to calculate the cardiac uptake ratio of BMIPP to thallium (H/MBMIPP:H/MTl).

Outcome

Overall mortality (cardiac death, defined as progressive heart failure or sudden death within 1h of symptom onset) at mean 660 days follow-up.hard clinical

The ratio of cardiac uptake of 123I-BMIPP to 201Tl is an independent predictor of cardiac death in patients with chronic heart failure, outperforming LVEF.

Main Result

Hazard Ratio: 5.57 (95% CI 1.14–27.3)

p-value: p=0.034

Limitations

Small number of subjects limited the value of subgroup analysis
Prognostic value compared with only a small number of echocardiographic and radiographic variables
Correlations with other clinical variables like peak oxygen uptake were not analyzed
Cost of examination is relatively expensive as both 201Tl and 123I BMIPP imaging were necessary
Markedly decreased BMIPP uptake in severely ill patients precluded clinically meaningful tomographic imaging

Abstract

In the present study, the effectiveness of 123I-beta-methyliodophenyl pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) for predicting cardiac death of patients with chronic heart failure was evaluated. Abnormalities of fatty acid metabolism are found in patients with chronic heart failure and BMIPP was developed as a tracer for scintigraphic assessment of myocardial fatty acid utilization. The study group comprised 74 patients with chronic heart failure with a left ventricular ejection fraction (LVEF) <45% on left ventriculography or radionuclide angiocardiography. They underwent both 201Tl SPECT and BMIPP SPECT. The uptake of tracer was scored semiquantitatively from 0 (normal) to 4 (defect) in 20 segments and a total defect score (TDS) for all 20 segments was calculated. On planar images the mediastinum to heart count ratio (H/M) was calculated for the BMIPP and Tl studies, and the H/M(BMIPP):H/M(Tl) (H/M(BMIPP) divided by H/M(Tl)) was also calculated. The mean follow-up period was 660 days and there were 17 cases of cardiac death. Multivariate analysis identified H/M(BMIPP):H/M(Tl) (p<0.05) and LVEF (p<0.05) as independent predictors of cardiac death. The receiver-operating characteristic curve of H/M(BMIPP):H/M (Tl) was situated to the left relative to LVEF. Analysis of the myocardial metabolism by BMIPP SPECT can predict the high-risk patients with chronic heart failure.

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