Cardiac SPECT with iodine-123-labeled fatty acids: evaluation of myocardial viability with BMIPP.

The use of 123I-labeled fatty acids is witnessing a resurgence of interest, primarily because of data from recent clinical protocols comparing regional myocardial uptake of 123I-labeled 15-(p-iodophenyl)-3-(R,S)-methylpentandecanoic acid (BMIPP) with flow tracers. Comparison of mismatches in BMIPP and flow tracer distribution (BMIPP < flow tracer) has demonstrated the usefulness of evaluating myocardial viability with BMIPP. BMIPP was introduced in 1993 as "Cardiodine" as an approved radiopharmaceutical in Japan by Nihon Medi-Physics, Inc. This article reviews the clinical use of BMIPP in the assessment of cardiomyopathy, myocardial infarction, ischemic heart disease and for the evaluation of myocardial viability in comparison with PET tracers. The results of two specific protocols demonstrating the utility of using BMIPP to detect viable myocardium are described in detail. The first study compares BMIPP and sestamibi uptake to wall motion and inotropic reserve after acute myocardial infarction in conjunction with two-dimensional echocardiography and low-dose dobutamine stimulation. The second example describes results of a triple SPECT technique using BMIPP reinjection for the assessment of ischemia.