Key result
Positive rest I-123 BMIPP despite negative stress Tl-201 imaging was associated with a significantly reduced 2-year event-free survival (71%) compared to patients with both tests negative (100%, p<0.005).
Why the study?
Does the addition of resting BMIPP to stress 201Tl imaging improve the identification and prognostication of significant CAD in patients with suspected CAD?
Cohort (n=105)
Blinded assessors
No
Does the addition of resting BMIPP to stress 201Tl imaging improve the identification and prognostication of significant CAD in patients with suspected CAD?
Absolute Event Rate: 71% vs 100%
p-value: p=<0.005
Adding resting BMIPP metabolic imaging to stress 201Tl perfusion imaging helps identify patients with significant CAD and increased risk of cardiac events who have false-negative stress perfusion results.
May identify higher-risk CAD patients missed by stress Tl-201 alone; leaves open prospective validation before changing practice.
BACKGROUND: There is frequently discordance in the interpretation of myocardial single-photon emission computed tomography images using both rest iodine-123 15-(p-iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) and stress thallium-201 ((201)Tl); that is, negative BMIPP vs positive (201)Tl studies. However, little attention has been paid to reverse discordance (ie, positive BMIPP despite negative stress (201)Tl). METHODS AND RESULTS: In the present study 105 consecutive patients with suspected coronary artery disease (CAD) who underwent both rest BMIPP and stress (201)Tl imaging were evaluated. No patient with previous myocardial infarction was included. Scintigraphic studies revealed that BMIPP was in concordance with (201)Tl in 71 patients: both were positive in 38 and negative in 33, whereas both were discordant in 20 and reverse discordant in 14. In patients with reverse discordance, the pattern of BMIPP abnormality was segmental in 8 and spotty in 6; the former was related to coronary territory. Based on the BMIPP findings and clinical symptoms, 7 patients with positive BMIPP despite negative (201)Tl underwent coronary angiography: 3-vessel CAD was found in 3 patients, 2-vessel CAD in 1, coronary spasm in 2, and insignificant lesions in 1. In the remaining 7 patients, no cardiac event was observed during 2-year follow-up. CONCLUSIONS: In patients showing positive BMIPP despite negative (201)Tl, a segmental BMIPP perfusion abnormality indicates a high likelihood for CAD, despite normal stress (201)Tl imaging. Thus, adding BMIPP to (201)Tl imaging may help to better identify patients with significant CAD, including multivessel disease.
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Hatano et al. (2006) conducted a cohort in Suspected coronary artery disease (n=105). Positive rest I-123 BMIPP despite negative stress Tl-201 imaging vs. Negative rest I-123 BMIPP and negative stress Tl-201 imaging was evaluated on Event-free survival at 2 years (cardiac death, nonfatal MI, PCI, CABG, or admission for heart failure/unstable angina) (p=<0.005). Positive rest I-123 BMIPP despite negative stress Tl-201 imaging was associated with a significantly reduced 2-year event-free survival (71%) compared to patients with both tests negative (100%, p<0.005).
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