Prognostic Value of Iodine-123-beta-methyl Iodophenyl-pentadecanoic Acid in Clinical Outcomes for Hypertrophic Cardiomyopathy by Single Photon Emission Computed Tomography With A Solid-state Dedicated Cardiac Camera

Introduction: Impaired regional fatty acid utilization has been demonstrated using Iodine-123-beta-methyl iodophenyl-pentadecanoic acid (BMIPP) by comparing the perfusion images, and may provide the substrate for ventricular arrhythmias in hypertrophic cardiomyopathy (HCM). Single photon emission computed tomography (SPECT) using a solid-state dedicated cardiac camera (D-SPECT) provides precise evaluation of tracer uptake and reduction of radiation dose in HCM by high sensitivity and high spatial resolution. However, little has been reported about the prognostic value of BMIPP image in HCM. Objective: The aim of this study was to evaluate the utility of BMIPP using D-SPECT in predicting cardiac adverse events in patients with HCM. Methods: We studied 122 consecutive HCM patients who underwent dual myocardial SPECT with a solid-state dedicated cardiac camera using BMIPP and technetium-99m sestamibi (MIBI) or thallium-201 (TL). Mismatch scores (MS) were calculated from the differences between the BMIPP and MIBI/TL scores. All of the patients were divided into a high MS group and a low MS group by ROC analysis for predicting cardiac adverse events. The primary end point was the composite of cardiac death and life-threatening arrhythmic events (sustained ventricular tachycardia, ventricular fibrillation, and appropriate ICD therapy). Results: Analysis of the ROC curve revealed the cutoff value of MS was 151.5 (AUC: 0.731). The high MS group had significantly more life-threatening arrhythmic events than the low MS group (p Conclusions: Abnormal uptake of BMIPP in HCM patients can predict adverse cardiac outcome. BMIPP imaging is a useful modality for risk stratification in HCM patients.