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. 2006 Dec 5;27(4):204–210. doi: 10.1002/clc.4960270406

Dynamic 123I‐BMIPP single‐photon emission computed tomography in patients with congestive heart failure: Effect of angiotensin ii type‐1 receptor blockade

Yasuchika Takeishi 1,✉, Osamu Minamihaba 1, Sou Yamauchi 1, Takanori Arimoto 1, Osamu Hirono 1, Hiroki Takahashi 1, Hideyuki Akiyama 1, Takuya Miyamoto 1, Joji Nitobe 1, Naoki Nozaki 1, Hidetada Tachibana 1, Masaki Okuyama 1, Akio Fukui 1, Isao Kubota 1, Akio Okada 2, Kazuei Takahashi 2
PMCID: PMC6654307  PMID: 15119694

Abstract

Background: Heart failure is a major and growing public health problem with a high mortality rate. Although recent studies have demonstrated that a variety of metabolic and/or neurohumoral factors are involved in the progression of this syndrome, the precise mechanisms responsible for this complex condition are poorly understood.

Hypothesis: To examine 123I‐β‐methyl‐iodophenylpentadecanoic acid (BMIPP) kinetics in the early phase soon after tracer injection in patients with congestive heart failure (CHF), we performed dynamic single‐photon emission computed tomography (SPECT).

Methods: Twenty‐six patients with CHF and eight control subjects were examined. The consecutive 15 images of 2‐min dynamic SPECT were acquired for 30 min after injection. In the early phase after injection (0‐4 min), a significant amount of radioactivity existed in the blood pool. After 6 min, the myocardial 123I‐BMIPP image was clear and thus the washout rate of 123I‐BMIPP from 6 to 30 min was calculated.

Results: The washout rate of 123I‐BMIPP from the myocardium was faster in patients with CHF than in the controls (8 ± 4 vs. −5 ± 3%, p<0.01). The washout rate of 123I‐BMIPP demonstrated positive correlation with left ventricular (LV) end‐diastolic volume index (R = 0.54, p < 0.02) and inverse correlation with LV ejection fraction (R = 0.53, p < 0.02). Patients were given the angiotensin II type‐1 receptor antagonist candesartan for 6 months, and dynamic SPECT was repeated. The enhanced washout rate of 123I‐BMIPP in CHF was reduced after treatment with candesartan (p < 0.05).

Conclusion: These data suggest that (1) enhanced washout of 123I‐BMIPP was observed soon after injection in patients with CHF, (2) the activation of angiotensin II signaling pathway is involved as an intracellular mechanism for enhanced 123I‐BMIPP washout in heart failure, and (3) improvement in fatty acid metabolism may represent a new mechanism for beneficial effects of angiotensin II receptor blockade on cardiac function and survival in patients with heart failure. 123I‐BMIPP washout in the early phase obtained from dynamic SPECT may be a new marker for evaluating the severity of heart failure and the effects of medical treatment.

Keywords: heart failure, angiotensin II receptor blockade, fatty acid metabolism, 123I‐BMIPP

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