Triglyceride deposit cardiomyovasculopathy (TGCV) is a rare metabolic heart disease characterized by defective intracellular triglyceride hydrolysis, resulting in diffuse dysfunction of myocardial fatty acid metabolism. 123 I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) scintigraphy serves as the primary diagnostic modality, whereas myocardial fluorodeoxyglucose (FDG) positron emission tomography findings remain poorly characterized. We report a case of a patient with TGCV and a history of coronary artery bypass grafting (CABG) who exhibited segmental metabolic heterogeneity on dual-tracer imaging. BMIPP scintigraphy demonstrated globally reduced washout, confirming impaired fatty acid metabolism. Regional discordance between BMIPP and FDG uptake revealed a mosaic of viable myocardium, metabolically inactive scar, and relatively preserved segments. This case underscores the value of dual-tracer imaging in differentiating TGCV-related metabolic dysfunction from ischemic myocardial injury.
Kasai et al. (Mon,) studied this question.