Reduced 123I-BMIPP uptake implies decreased myocardial flow reserve in patients with chronic stable angina

Eur J Nucl Med Mol Imaging. 2006 Jan;33(1):6-12. doi: 10.1007/s00259-005-1863-3. Epub 2005 Jul 23.


Purpose: Long-chain fatty acid (LCFA) is the main energy source for normal myocardium at rest, but in ischemic myocardium, the main energy substrate shifts from LCFA to glucose. 123I-BMIPP is a radiolabeled LCFA analog. In chronic stable angina without previous infarction, we suppose that reduced 123I-BMIPP uptake is related to the substrate shift in myocardium with decreased myocardial flow reserve (MFR). The purpose of this study was to relate 123I-BMIPP uptake to rest myocardial blood flow (MBF), hyperemic MBF, and MFR assessed with 15O-water positron emission tomography (PET).

Methods: We enrolled 21 patients with chronic stable angina without previous infarction, all of whom underwent 123I-BMIPP single-photon emission computed tomography (SPECT) and 15O-water PET. The left ventricle was divided into 13 segments. In each segment, rest MBF and hyperemic MBF were measured by PET. 123I-BMIPP uptake was evaluated as follows: score 0=normal, 1=slightly decreased uptake, 2=moderately decreased uptake, 3=severely decreased uptake, and 4=complete defect. 123I-BMIPP uptake was compared with rest MBF, hyperemic MBF, and MFR.

Results: The numbers of segments with 123I-BMIPP scores 0, 1, 2, 3, and 4 were 178, 40, 25, 24, and 0, respectively. The rest MBFs for scores 0, 1, 2, and 3 were 0.93+/-0.25, 0.86+/-0.21, 0.97+/-0.30, and 0.99+/-0.37 ml/min/g, respectively. The hyperemic MBFs for scores 0, 1, 2, and 3 were 2.76+/-1.29, 1.84+/-0.74, 1.37+/-0.39, and 1.08+/-0.40 ml/min/g, respectively. The MFRs for scores 0, 1, 2, and 3 were 3.01+/-1.38, 2.20+/-0.95, 1.44+/-0.22, and 1.10+/-0.26, respectively. As 123I-BMIPP uptake declined, hyperemic MBF and MFR decreased.

Conclusion: In chronic stable angina without previous infarction, reduced 123I-BMIPP uptake implies decreased MFR.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Angina, Unstable / diagnostic imaging*
  • Angina, Unstable / etiology
  • Angina, Unstable / metabolism*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / metabolism
  • Coronary Circulation
  • Fatty Acids / metabolism*
  • Fatty Acids / pharmacokinetics
  • Female
  • Humans
  • Iodobenzenes / pharmacokinetics*
  • Male
  • Middle Aged
  • Oxygen Radioisotopes / pharmacokinetics
  • Radionuclide Imaging
  • Radiopharmaceuticals / pharmacokinetics
  • Risk Assessment / methods
  • Risk Factors


  • Fatty Acids
  • Iodobenzenes
  • Oxygen Radioisotopes
  • Radiopharmaceuticals
  • iodofiltic acid