BMIPP imaging to improve the value of sestamibi scintigraphy for predicting functional outcome in severe chronic ischemic left ventricular dysfunction.

UNLABELLED: Mismatching between beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and perfusion accurately predicts functional outcome after acute myocardial infarction. The current investigation was aimed at evaluating the value of this method to predict the evolution of global function according to the applied treatment in patients with chronic ischemic heart disease. METHODS: Twenty patients with infarction and chronic left ventricular dysfunction were studied (median infarction age 12 wk, range 2 wk-15 y). Radionuclide angiography, two-dimensional echocardiography and BMIPP and gated sestamibi scintigraphy were performed with the patient at rest before and >6 mo after treatment (revascularization in 13 patients and conservative therapy in 7 patients). In 7 patients, radionuclide angiography was repeated after 1 y. RESULTS: On a patient basis, mismatching with BMIPP less than sestamibi was noted in 15 patients at baseline. Of these 15 patients, 11 had significant functional improvement at follow-up versus only 1 of the 5 patients with a matched decreased uptake. Hence, the combined sestamibi/BMIPP was 73% positive and 80% negative in predicting functional outcome, with a global accuracy of 75%. On a segmental basis, using an optimal threshold of uptake defined by receiver operating characteristic curve analysis, sestamibi was only 63% accurate in predicting regional outcome. Adding BMIPP improved the accuracy to 80% (P = 0.001). At follow-up, significant mismatching was still noted in 7 patients in the revascularized group and 1 in the medically treated group. The mismatch was associated with a further increase in ejection fraction at 1-y follow-up in only the revascularized group. CONCLUSION: In patients with chronic left ventricular dysfunction after infarction, a mismatching with BMIPP less than sestamibi reliably identifies jeopardized but viable myocardium and predicts functional recovery with an accuracy similar to that reported in the acute and subacute phases of the infarction.

Abnormal BMIPP uptake in chronically dysfunctional myocardial segments: correlation with contractile response to low-dose dobutamine.

UNLABELLED: Discordance between 123I-15-(p-iodophenyl)-3-(R,S)-methyl pentadecanoic acid (BMIPP) and sestamibi uptake has been described as a good predictor of functional recovery in patients with a recent myocardial infarction. The current investigation aimed at evaluating BMIPP as a viability tracer in patients with chronic ischemic left ventricular dysfunction. METHODS: Thirty-one studies were obtained in 25 patients with severe left ventricular dysfunction postinfarction (median infarction age 3.6 mo; range 2 wk-15 yr). All patients underwent dobutamine stress echocardiography and a resting 99mTc-sestamibi/123I-BMIPP SPECT study in a 3-day interval. The relative uptake of the two tracers was compared to the evolution of wall motion during dobutamine infusion in 8 matched myocardial segments. RESULTS: Among the 130 segments with abnormal wall motion at rest, 70 improved under dobutamine. Using sestamibi, a normal uptake was 88% predictive of a positive response to dobutamine, and a decreased uptake of 63% predicted negative stress echocardiography response. In the segments with abnormal sestamibi uptake, adding BMIPP significantly increased the accuracy of scintigraphy to detect residual viability; 28 of 48 segments (58%) with a mismatched pattern demonstrating residual inotropic reserve under dobutamine infusion versus only 5 of 40 segments (13%) with a matched defect. Global agreement between the two approaches was 77%, and positive and negative predictive values for scintigraphy were 72% and 88%, respectively. CONCLUSION: In patients with chronic ischemic left ventricular dysfunction, the combined assessment of metabolism and perfusion with 123I-BMIPP and 99mTc-sestamibi correlates well with the response of wall motion to dobutamine during stress echocardiography and is more sensitive than sestamibi alone for differentiating viable from scar segments.

Fusarium endocarditis involving aortic valve following coronary artery surgery.

This article describes a case of infective aortic valve endocarditis due to Fusarium oxysporum occurring 4 years after coronary artery bypass grafting. It is the first reported case of endocarditis caused by Fusarium.

Myxoma with a left-to-left shunt and fistula.

We present the case of a 68-year-old man with a peculiar coincidence of cardiac pathologic findings: a huge left atrial myxoma, mitral insufficiency, a high degree atrioventricular block and three-vessel disease. The myxoma was vascularized from a dilated sinus arteriosus branch, giving rise to neovascularization at the base of the tumor. Blood from the neovascularization gathered into a large cavern which fistulated into the left atrium, responsible for a left-to-left cardiac shunt.

Amiodarone induced torsades de pointe. Report of three cases and review of literature.

The occurrence of torsades de pointe is often associated with the use of drugs. We report three cases of amiodarone-induced torsades de pointe. Although a lot of amiodarone-induced torsades de pointe have been published, a review of all these cases and the underlying risk-factors has never been made.

Epicardial crossing of coronary arteries: a variation of coronary arterial anatomy.

Four patients with crossing of two coronary arteries detected by coronary arteriography are presented. This variation of coronary artery anatomy has not yet been reported. The classification of this variation is discussed.

Myocardial involvement in acromegaly.

We recently encountered a case of an acromegalic patient with congestive heart failure and secondary cardiomyopathy. Cardiac biopsies were available in addition to autopsy material. This enabled us to perform electron microscopical studies which have hitherto not been reported. This may help to clarify the relationship between these two conditions and reveal specific characteristics.