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Heart 1999;81:153-159 ( February )
a Division
of Cardiology, National East Nagano Hospital, Nagano, Japan, b First Department of Internal Medicine, Shinshu
University, Asahi 3-1-1, Matsumoto 390, Japan
Correspondence to: Dr Isobe.
Accepted for publication 7 September 1998
Objective
To determine
the clinical and prognostic value of identifying metabolic
abnormalities of myocardial fatty acid metabolism in idiopathic dilated
cardiomyopathy using iodine-123 
-methyl-iodophenyl pentadecanoic
acid (123I BMIPP).
SettingCardiac care
division in national hospital.
Patients32
consecutive patients with idiopathic dilated cardiomyopathy in whom
both 123I BMIPP and thallium-201 myocardial single photon
emission computed tomography were performed.
MethodsThe
uptake of each tracer was scored visually from 0 (normal) to 3 (defect)
in 17 segments (eight basal, eight midventricular, and one apical). A
total score for all 17 segments was compared with clinicopathological
variables. Prognostic value of mismatches between the two tracers were
also evaluated.
ResultsThe
123I BMIPP total score was correlated with pulmonary
capillary wedge pressure (r = 0.68,
p < 0.001), left ventricular end diastolic pressure
(r = 0.65, p < 0.001), percentage
fractional shortening at six months' follow up
(r = -0.58, p = 0.001), myocyte diameter
(r = 0.66, p < 0.001), and percentage
area of interstitial fibrosis (r = 0.69,
p < 0.001) measured by morphometry in the biopsy specimens. During a
mean (SD) follow up of 20 (11) months, deterioration of the New York
Heart Association functional class was observed in 11 of the 32 patients; four of these died. Segments with a greater decrease in
123I BMIPP than thallium-201 uptake (type B mismatching)
were often observed in patients with deterioration (88/187, 29%
v 58/357, 16%; p < 0.001).
ConclusionsThe extent
of the abnormality of myocardial fatty acid metabolism in idiopathic
dilated cardiomyopathy reflects the severity of haemodynamic
deterioration and histopathological changes. Type B mismatching is one
of the important prognostic indicators in idiopathic dilated cardiomyopathy.
-methyl-iodophenyl pentadecanoic acid
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