Prognostic Value of 123I-BMIPP SPECT in Patients with Nonischemic Heart Failure with Preserved Ejection Fraction

Imaging of myocardial fatty acid metabolism using I-123-betamethyl-p- iodophenyl-pentadecanoic acid (I-123-BMIPP) SPECT is useful for identifying high-risk patients with known ischemic heart disease. However, its utility for patients who have nonischemic heart failure with preserved ejection fraction is not well known. This study aimed to evaluate the prognostic value of the I-123-BMIPP defect score in such patients. Methods: Of 804 consecutive patients who were admitted to the hospital because of acute heart failure and underwent I-123-BMIPP SPECT, we identified 133 (mean age +/- SD, 73 +/- 13 y) who had normal coronary arteries by invasive coronary angiography and preserved left ventricular ejection fraction (>= 50%) by echocardiography. I-123-BMIPP defects were quantitatively scored to obtain summed defect scores in 17 segments of I-123-BMIPP SPECT images. The patients were divided into 2 groups based on their score. The multivariate Cox model was used to assess a possible correlation between a higher score (>= 4, n = 46) and major adverse cardiac events, including cardiac death, cardiovascular events, and hospitalization for heart failure, compared with a lower score (<4, n = 87). Results: During a mean follow-up of 2.5 y, 35 major adverse cardiac events occurred. The median scores in the high-score and low-score groupswere 7.13 +/- 4.21 and 1.29 +/- 0.80, respectively. By multivariate Cox analysis, a higher score was associated with increased major adverse cardiac events, compared with a lower score (hazard ratio, 11.04; 95% confidence interval, 4.93-24.74; P < 0.001). Conclusion: This study demonstrated that the defect score by I-123-BMIPP SPECT may have potential prognostic value in patients who have nonischemic heart failure with preserved ejection fraction.