Myocardial Metabolic Abnormalities in Hypertrophic Cardiomyopathy Assessed by Iodine-123-Labeled Beta-Methyl-Branched Fatty Acid Myocardial Scintigraphy and its Relation to Exercise-Induced Ischemia

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Reversible thallium-201 (^<201>Tl) abnormalities during exercise stress have been used as markers of myocardial ischemia in hypertrophic cardiomyopathy (HCM) and are most likely to identify relatively underperfused myocardium. Although metabolic abnormalities in HCM were reported, the relationship between impaired energy metabolism and exercise-induced ischemia has not been fully elucidated as yet. To assess the relationship between myocardial perfusion abnormalities and fatty acid metabolic abnormalities, 28 patients with HCM underwent exercise ^<201>Tl and rest ^<123>I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy. Perfusion abnormalities were observed by exercise ^<201>Tl in 19/28 patients with HCM.^<123>I-BMIPP uptake was decreased compared with delayed ^<201>Tl in 106/364 (29%) of the total myocardial segments (p<0.01, McNemar symmetry test). Such disparity between ^<123>I-BMIPP and ^<201>Tl was observed more often in the 49/75 (65%) segments with reversible exercise ^<201>Tl defects (p<0.001). Our results indicate that exercise-induced myocardial ischemia exists in HCM, resulting in metabolic abnormalities. The combination of 123I BMIPP and ^<201>Tl suggests that myocardial isehemia may play an important role in metabolic abnormalities in HCM.
社団法人日本循環器学会の論文
1998-02-20