Improved myocardial fatty acid metabolism after coronary angioplasty in chronic coronary artery disease

This study assessed the utility of myocardial fatty acid imaging using I-123-labeled 15-(beta-methyl-p-iodophenyl-pentadecanic acid (BMIPP) to evaluate improvement after percutaneous transluminal coronary angioplasty in patients with chronic coronary artery disease. Methods: Thirty-eight patients (18 old myocardial infarction and 20 angina pectoris patients) with chronic coronary artery stenosis and 8 control subjects were enrolled in this study. All patients underwent successful angioplasty, and BMIPP SPECT was performed before and after angioplasty. SPECT images were divided into 13 segments and scored visually from 0 (normal uptake) to 4 (defect). The defect score was calculated as the summation of the total scores in each patient. The regional washout rate was calculated in both the reperfused areas and normal uptake areas using a bull's-eye map. Results: In nonrestenosis patients, BMIPP defect scores before and after angioplasty did not change on the initial image (9.6 +/- 9.3 compared to 9.0 +/- 9.2, nonsignificant p value), whereas they improved significantly on the delayed image (9.9 +/- 8.8 compared to 8.2 +/- 8.7, p < 0.05). In nonrestenosis patients, BMIPP washout rate in reperfused areas after angioplasty was significantly lower than that before angioplasty and the washout rate in control subjects (22.9% +/- 8.4% compared to 31.5% +/- 10.6% and 29.5% +/- 8.0%, p < 0.01 and p < 0.05, respectively). In restenosis patients, BMIPP washout rate in both reperfused areas and normal uptake areas did not change after angioplasty. Conclusion: These data suggest that decreased BMIPP washout rate after angioplasty indicates improved fatty acid utilization in patients with chronic coronary artery disease.