Skip to main content

Advertisement

SpringerLink
Log in

Uncommon and dynamic changes detected by123I-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid myocardial single photon emission computed tomography in a stunned myocardium induced by coronary microvascular spasm

  • Case Reports
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

A 55-yr-old man underwent surgery. Soon after the procedure was finished, the patient complained of chest pain, and the electrocardiogram showed increase in the ST-segment in some leads. Emergency angiography showed normal coronary arteries, but there was asynergy in the left ventricle, and delayed filling of contrast medium was observed in the LCA. An intracoronary infusion of isosorbide dinitrate did not improve the delayed filling of contrast medium or ST segment increase in the electrocardiogram. Soon after nicorandil was injected into the LCA, the patient's symptoms, electrocardiogram, and delayed filling of contrast medium dramatically improved. On the second day, initial imaging by123I-BMIPP myocardial SPECT showed a moderate increase in tracer uptake in the apico-anteroseptal region and a moderate decrease in tracer uptake in the lateral region, in which the first left ventriculography showed akinesis, and delayed imaging revealed a moderate increase in tracer uptake in the apical region and a high washout of123I-BMIPP in the anteroseptal and lateral regions. On the sixth day, initial imaging by123I-BMIPP myocardial SPECT showed a moderate decrease in tracer uptake in the apical and lateral regions and a mild decrease in tracer uptake in the anteroseptal region, and delayed imaging revealed a moderate increase in tracer uptake in the apical region and a high washout of123I-BMIPP in the anteroseptal and lateral regions. By the 30th day,123I-BMIPP myocardial SPECT had normalized. We consider that these dynamic changes in123I-BMIPP myocardial SPECT imaging may reflect metabolic changes in fatty acids in the ischemic state, the size of the triacylglycerol pool, and the degree of turnover in the triacylglycerol pool.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Reske SN, Sauer W, Machulla HJ, Knust J, Winkler C. Metabolism of 15 (p-123I-iodophenyl-) pentadecanoic acid in heart muscle and non cardiac tissue.Eur J Nucl Med 10: 228–234, 1985.

    Article  CAS  PubMed  Google Scholar 

  2. Goodmann MM, Kirsch G, Knapp FF Jr. Synthesis and evaluation of radioiodinated terminal p-iodophenyl-substituted alpha- and beta-methyl branched fatty acids.J Med Chem 27: 390–397, 1984.

    Article  Google Scholar 

  3. Knapp FF Jr, Ambrose KR, Goodmann MM. New radioiodinated methyl-branched fatty acids for cardiac studies.Eur J Nucl Med 12: S39-S44, 1986.

    CAS  PubMed  Google Scholar 

  4. Tamaki N, Kawamoto M, Yonekura Y, Fujibayashi Y, Takahashi N, Konishi T, et al. Regional metabolic abnormality in relation to perfusion and wall motion in patients with myocardial infarction: Assessment with emission tomography using an iodinated branched fatty acid analog.J Nucl Med 33: 659–667, 1992.

    CAS  PubMed  Google Scholar 

  5. Lopaschuk GD, Belke DD, Gamble J, Itoi T, Schonekess BO. Regulation of fatty acid oxidation in the mammalian heart in health and disease.Biochem Biophys Acta 1213: 263–276, 1994.

    CAS  PubMed  Google Scholar 

  6. Yamamichi Y, Kusuoka H, Morishita K, Shirakami Y, Kurami M, Okano K, et al. Metabolism of iodine-123-BMIPP in perfused rat hearts.J Nucl Med 36: 1043–1054, 1995.

    CAS  PubMed  Google Scholar 

  7. Tanaka T, Okamoto F, Sohmiya K, Keishiro K. Lack of myocardial iodine-123 15-(p-iodiphenyl)-3-R,S-methyl-pentadecanoic acid (BMIPP) uptake and CD36 abnormality.Jpn Circ J 61: 724–725, 1997.

    Article  CAS  PubMed  Google Scholar 

  8. Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty-acids and arrhythmias and death after acute myocardial infarction.Lancet 1: 710–714, 1968.

    Article  CAS  PubMed  Google Scholar 

  9. Corr PB, Gross RW, Sobel BE. Amphipathic metabolites and membrane dysfunction in ischemic myocardium.Circ Res 55: 135–154, 1984.

    CAS  PubMed  Google Scholar 

  10. Katz AM, Messineo FC. Lipid-membrane interactions and the pathogenesis of ischemic damage in the myocardium.Circ Res 48: 1–16, 1984.

    Google Scholar 

  11. Liedtke AJ. Alteration of carbohydrates and lipid metabolism in the acutely ischemic heart.Prog Cardiovasc Dis 23: 321–336, 1981.

    Article  CAS  PubMed  Google Scholar 

  12. Mjos OD. Effect of free fatty acids on myocardial function and oxygen consumption in intact dogs.J Clin Invest 50: 1386–1389, 1978.

    Article  Google Scholar 

  13. Liedtke AJ, Nellis SH, Neely JR. Effects of excess free fatty acids on ischemic myocardium in swine.Circ Res 43: 652–661, 1978.

    CAS  PubMed  Google Scholar 

  14. Hendrickx GR, Wijns W, Vogelaers D, Dogrieck Y, Bol A, Vandeplassche G, et al. Recovery of regional contractile function and oxidative metabolism in stunned myocardium induced by 1-hour circumflex coronary artery stenosis in chronically instrumented dogs.Circ Res 72: 901–913, 1993.

    Google Scholar 

  15. Tsubokawa A, Lee JD, Shimizu H, Nakano A, Usui H, Takeuchi M, et al. Recovery of perfusion, glucose utilization and fatty acid utilization in stunned myocardium.J Nucl Med 38: 1835–1837, 1997.

    CAS  PubMed  Google Scholar 

  16. Ito K, Shudo T, Kohno Y, Asayama J, Katume H, Nakagawa M, et al. A case of myocardial ischemia associated with delayed opacification of the left anterior descending artery.Kokyu to Junkan 42: 1211–1215, 1994.

    Google Scholar 

  17. Chen JW, Lee WL, Lin SJ, Ting CT, Wang SP, Chang MS. Effects of short-term treatment of nicorandil on exercise-induced myocardial ischemia and abnormal cardiac autonomic activity in microvascular angina.Am J Cardiol 80: 32–38, 1997.

    Article  CAS  PubMed  Google Scholar 

  18. Maeda N, Hiraoka H, Kobayashi H, Yamashita S, Takemura K, Matsuzawa Y. Acetylcholine-induced coronary microvascular vasospasm in a patient with angina pectoris and normal coronary angiogram.Angiology 48: 995–999, 1997.

    Article  CAS  PubMed  Google Scholar 

  19. Elian D, Harpaz D, Sucher E, Kaplinsky E, Motro M, Vered Z. Reversible catecholamine-induced cardiomyopathy presenting as acute pulmonary edema in a patient with pheochromocytoma.Cardiology 83: 118–120, 1993.

    Article  CAS  PubMed  Google Scholar 

  20. Sugano S, Asahara T, Enoki M, Takeda J, Sugi K, Masuyama Y. Two cases of suspected catecholamine-induced cardiomyopathy associated with surgical operations.Kokyu to Junkan 46: 409–414, 1998.

    Google Scholar 

  21. Nishimura T, Sago M, Kihara K, Oka H, Shimonagata T, Katabuchi T, et al. Fatty acid myocardial imaging using123I-β-methyl-iodophenyl pentadecanoic acid (BMIPP): comparison of myocardial perfusion and fatty acid utilization in canine myocardial infarction (occlusion and reperfusion model).Eur J Nucl Med 15: 341–345, 1989.

    Article  CAS  PubMed  Google Scholar 

  22. Straeter-Knowlen IM, Evanochko WT, Balschi JA, Caulfield JB, Ku DD, Pohost GM, et al.1H NMR spectroscopic imaging of myocardial triglycerides in excised dog hearts subjected to 24 hours of coronary occlusion.Circulation 93: 1464–1470, 1996.

    CAS  PubMed  Google Scholar 

  23. Ito K, Sugihara H, Terada K, Matumoto K, Taniguchi Y, Ohtsuki K, et al. Assessment of myocardial fatty acid metabolism in patients with vasospastic angina using123I-BMIPP myocardial SPECT.KAKU IGAKU (Jpn J Nucl Med) 32: 1099–1106, 1995.

    CAS  Google Scholar 

  24. Tanaka K, Ito K, Kinoshita N, Nakagawa M, Terada K, Kajita Y, et al. Importance of the delayed123I-BMIPP image for detecting myocardial metabolic abnormality induced by transient myocardial ischemia: a case of vasospastic angina.KAKU IGAKU (Jpn J Nucl Med) 34: 229–235, 1997.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Murakami Memorial Hospital, Asahi University, 3-23 Hashimoto-cho, 500-8523, Gifu, Japan

    Kan Zen, Kazuki Ito, Takato Hikosaka, Yoshihiko Adachi, Satoshi Yoneyama & Shuji Katoh

  2. Second Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Akihiro Azuma & Masao Nakagawa

  3. Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Hiroki Sugihara

Authors
  1. Kan Zen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takato Hikosaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshihiko Adachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoshi Yoneyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shuji Katoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akihiro Azuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroki Sugihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masao Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kan Zen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zen, K., Ito, K., Hikosaka, T. et al. Uncommon and dynamic changes detected by123I-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid myocardial single photon emission computed tomography in a stunned myocardium induced by coronary microvascular spasm. Ann Nucl Med 14, 303–309 (2000). https://doi.org/10.1007/BF02988215

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02988215

Key words

Search

Navigation