Dynamic myocardial scintigraphy with 123I-labeled free fatty acids in patients with myocardial infarction.

We have already shown that myocardial imaging properties of radio-iodinated long-chain free fatty acids (123I-FFA) and thallium 201 (201TI) are comparable in detecting areas of inadequate myocardial perfusion (van der Wall et al. 1980). Besides confirming our earlier observations, the present study tests the potential of 123I-FFA, hexadecenoic acid (123I-16-ha), and heptadecanoic acid (123I-17-H degree A), in assessing regional myocardial metabolism in 30 patients within a week of proven myocardial infarction. The clearance rates (t1/2) of FFA were estimated from mono-exponential time-activity curves, obtained by external detection over infarcted and normally perfused areas during a 30-min period after IV administration of 3-5 mCi 123I-16-HA or 123I-17-H degree A. Six normal subjects served as controls. The t1/2 values in the infarcted areas were found to be significantly lower (18.5 +/- 2.1 min; mean +/- SD, with 123I-16-HA and 16.8 +/- 3.5 min with 123I-17-H degree A) than in non-infarcted areas (34.0 +/- 8.4 min with 123I-16-HA and 34.8 +/- 7.7 with 123I-17-H degree A). The t1/2 values in the control group (27.5 +/- 3.0 min with 123I-17-H degree A) were not significantly different from values found in non-infacted areas in the patient group. Our findings of faster FFA turn-over rates in infarcted tissue are in contrast to previous studies, which have shown prolonged turn-over rates in reversibly ischaemic myocardiu. We conclude that the study of turn-over rates of FFA provides a means to distinguish normally perfused, reversibly ischaemic and irreversibly ischaemic myocardium.