Skip to main content
SpringerLink
Log in

Myocardial scintigraphy with iodine-123 phenylpentadecanoic acid and thallium-201 in patients with coronary artery disease: a comparative dual-isotope study

  • Original Article
  • Published:
European Journal of Nuclear Medicine Aims and scope Submit manuscript

Abstract

To characterise the clinical usefulness of serial myocardial scintigraphy with iodine-123 phenylpentadecanoic acid (IPPA) in comparison with thallium-201, dual-isotope investigations were performed in 41 patients with angiographically documented coronary artery disease. Both tracers were administered simultaneously during symptom-limited ergometry. Planar scintigrams were acquired immediately after stress, and delayed imaging was performed after 1 h for IPPA and 4 h for 201Tl. Scintigrams were evaluated both qualitatively and quantitatively using a newly developed algorithm for automated image superposition. Initial myocardial uptake of both tracers was closely correlated (r=0.75, p<0.001). Both tracers also revealed a similar sensitivity for the identification of individual coronary artery stenoses ≥ 75% (IPPA: 70.0%, 201Tl: 66.3%, P=NS) with identical specificity (69.8%). The number of persistent defects, however, was significantly higher with IPPA (P=0.021), suggesting that visual analysis of serial IPPA scintigrams may over-estimate the presence of myocardial scar tissue. On the other hand, previous Q wave myocardial infarction was associated with a decreased regional IPPA clearance (29% ± 11% vs 44%±11% in normal myocardium, P<0.05). The data indicate that serial myocardial scintigraphy with IPPA is essentially as sensitive as scintigraphy with 201Tl for the detection of stress-induced perfusion abnormalities. Quantitative analysis of myocardial IPPA kinetics, however, is required for the evaluation of tissue viability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Appledorn CR, Oppenheim BE, Wellman HN (1980) An automated method for the alignment of image pairs. J Nucl Med 21:165–167

    Google Scholar 

  • Bonow RO, Dilsizian V, Cuocolo A, Bacharach SL (1991) Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction. Comparison of thallium scintigraphy with reinjection and PET imaging with F-18-fluorodeoxyglucose. Circulation 83:26–37

    Google Scholar 

  • Brunken RC, Schwaiger M, Grover-McKay M, Phelps ME, Tillisch J, Schelbert HR (1987) Positron emission tomography detects metabolic activity in myocardial segments with persistent thallium perfusion defects. J Am Coll Cardiol 10:557–567

    Google Scholar 

  • Caldwell JH, Martin GV, Link JM, Krohn KA, Bassingthwaighte JB (1990) Iodophenylpentadecanoic acid-myocardial blood flow relationship during maximal exercise with coronary occlusion. J Nucl Med 31:99–105

    Google Scholar 

  • Chien KR, Han A, White J, Kulkarni P (1983) In vivo esteriflcation of a synthetic 125I-labeled fatty acid into cardiac glycerolipids. Am J Physiol 245: H693-H697

    Google Scholar 

  • Chouraqui P, Maddahi J, Berman DS, Henkin R, Galie E, Fowler DR, Strauss HW (1989) Clinical comparison of iodine-123 fatty acid and thallium-201 for assessment of exercise induced myocardial ischemia (abstract). J Nucl Med 30:729

    Google Scholar 

  • DeGrado TR, Holden JE, Ng CK, Raffel DM, Gatley SJ (1989) Quantitative analysis of myocardial kinetics of 15-p-[iodine125] iodophenylpentadecanoic acid. J Nucl Med 30:1211–1218

    Google Scholar 

  • DeGrella RF, Light RJ (1980) Uptake and metabolism of fatty acids by dispersed adult rat heart myocytes. J Biol Chem 255:9731–9745

    Google Scholar 

  • Dilsizian V, Rocco TP, Freedman NMT, Leon MB, Bonow RO (1990) Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. N Engl J Med 323:141–146

    Google Scholar 

  • Fox KAA, Abendschein DR, Ambos HD, Sobel BE, Bergmann SR (1985) Efflux of metabolized and nonmetabolized fatty acid from canine myocardium. Implications for quantifiying myocardial metabolism tomographically. Circ Res 57:232–243

    Google Scholar 

  • Glatz JFC, van der Vusse GJ, Veerkamp JH (1983) Fatty acid-binding proteins and their physiological significance. News Physiol Sci 3:41–43

    Google Scholar 

  • Hansen CL, Corbett JR, Pippin JJ, Jansen DE, Kulkarni PV, Ugolini V, Henderson E, Akers M, Buja M, Parkey RW, Willerson JT (1988) Iodine-123 phenylpentadecanoic acid and single photon emission computed tomography in identifying left ventricular metabolic abnormalities in patients with coronary artery disease: comparison with thallium-201 myocardial tomography. J Am Coll Cardiol 12:78–87

    Google Scholar 

  • Huang XQ, Liedtke AJ (1989) Alterations in fatty acid oxidation in ischemic and reperfused myocardium. Mol Cell Biochem 88:145–153

    Google Scholar 

  • Hudon MPJ, Lyster DM, Jamieson EWR, Qayumi KA, Kiess MC, Rosado LJ, Autor AP, Sartori C, Dougan H, van den Broek J (1988) Efficacy of 15-(123I)-iodophenyl pentadecanoic acid (IPPA) in assessing myocardial metabolism in a model of reversible global ischemia. Eur J Nucl Med 14:594–599

    Google Scholar 

  • Kahn JK, Pippin JJ, Akers MS, Corbett JR (1989) Estimation of jeopardized left ventricular myocardium in symptomatic and silent ischemia as determined by iodine-123 phenylpentadecanoic acid rotational tomography. Am J Cardiol 63:540–544

    Google Scholar 

  • Kaiser KP, Geuting B, Großmann K, Vester E, Lösse B, Antar MA, Machulla HJ, Feinendegen LE (1990) Tracer kinetics of 15-(ortho-123/131I-phenyl)-pentadecanoic acid and 15-(para-123/131I-phenyl)-pentadecanoic acid in animals and man. J Nucl Med 31:1608–1616

    Google Scholar 

  • Kapp M, Zimmermann R, Tillmanns H, Seitz F, Eisenhut M, Bubeck B, Achenbach H, Saggau W, Mall G, Kubler W (1990) Quantitative scintigraphy with iodine-123 phenylpentadecanoic acid in patients with coronary artery disease. In: Schmidt HAE, Chamron J (eds) Nuclear medicine. Schattauer, Stuttgart, pp 227–229

    Google Scholar 

  • Kennedy PL, Corbett JR, Kulkarni PV, Wolfe CL, Jansen DE, Hansen CL, Buja LM, Parkey RW, Willerson JT (1986) Iodine 123-phenylpentadecanoic acid myocardial scintigraphy: usefulness in the identification of myocardial ischemia. Circulation 74:1007–1015

    Google Scholar 

  • Kiat H, Berman DS, Maddahi J, Yang L, van Train K, Rozanski A, Friedman J (1988) Late reversibility of tomography myocardial thallium-201 defects: an accurate marker of myocardial viability. J Am Coll Cardiol 6:1456–1463

    Google Scholar 

  • Knapp WH, Vyska K, Machulla HJ, Notohamiprodjo G, Schmidt U, Knust EJ, Gleichmann U (1988) Double-nuclide study of the myocardium using thallium-201 and iodine-123 labeled fatty acids in non-ischemic myocardial diseases. Nucl Med 27:72–78

    Google Scholar 

  • Kropp J, Likungu J, Kirchhoff PG, Knapp FF, Reichmann K, Reske SN, Biersack HJ (1991) Single photon emission tomography imaging of myocardial oxidative metabolism with 15-(p-I-123-iodophenyl)pentadecanoic acid in patients with coronary artery disease and aorto-coronary bypass graft surgery. Eur J Nucl Med 18:467–474

    Google Scholar 

  • Liedtke JA (1981) Alterations of carbohydrate and lipid metabolism in the acutely ischemic heart. Prog Cardiovasc Dis 23:321–36

    Google Scholar 

  • Liu P, Kiess MC, Okada RD, Block PC, Strauss HW, Pohost GW, Boucher CA (1985) The persistent defect of exercise thallium imaging and its fate after myocardial revascularization: Does it represent scar or ischemia? Am Heart J 110:996–100

    Google Scholar 

  • Machulla HJ, Marshmann M, Dutschka K (1980) Biochemical concept and synthesis of a radioiodinated phenyl fatty acid for in vivo metabolic studies of the myocardium. Eur J Nucl Med 5:171–173

    Google Scholar 

  • Nakajima K, Taki J, Bunko H, Shimizu M, Muramori A, Tonami N, Hisida K (1990) Error of uptake in dual energy acquisition with 201Tl and 123I labeled radiopharmaceuticals. Eur J Nucl Med 16:595–599

    Google Scholar 

  • Nielson AP, Morris KG, Murdock BS, Bruno FP, Cobb FR (1980) Linear relationship between the distribution of thallium-201 and blood flow in ischemic and nonischemic myocardium during exercise. Circulation 61:797–801

    Google Scholar 

  • Opie LH (1968) Metabolism of the heart. I. Metabolism of glucose, glycogen, free fatty acids and ketone bodies. Am Heart J 76:685–698

    Google Scholar 

  • Rauch B, Kübler W (1985) Kinetics of cellular uptake of tracers used in myocardial scintigraphy. Basic Res Cardiol 80 [Suppl I]:65–68

    Google Scholar 

  • Rauch B, Bode C, Piper HM, Hütter JF, Zimmermann R, Braunwell E, Hasselbach W, Kübler W (1987) Palmitate uptake in calcium tolerant, adult rat myocardial single cells — evidence for an albumin mediated transport across sarcolemma. J Mol Cell Cardiol 19:159–166

    Google Scholar 

  • Reske SN (1985) 123-I-phenyl pentadecanoic acid as a tracer of cardiac free fatty acid metabolism. Experimental and clinical results. Eur Heart J 6 [Suppl B]: 39–47

    Google Scholar 

  • Reske SN, Koischwitz D, Reichmann K, Machulla HJ, Simon H, Knopp R, Winkler C (1984a) Cardiac metabolism of 15(p-I-123-phenyl-)pentadecanoic acid after intracoronary tracer application. Eur J Radiol 4:144–149

    Google Scholar 

  • Reske SN, Schön S, Knust EJ, Machulla HJ, Eichelkraut W, Hahn N, Winkler C (1984b) Relation of myocardial blood flow and initial cardiac uptake of 15 (p-123–1-phenyl-)pentadecanoic acid in the canine heart. Nucl Med 23:83–85

    Google Scholar 

  • Rosamond TL, Abendschein DR, Sobel BE, Bergmann SR, Fox KAA (1987) Metabolic fate of radiolabeled palmitate in ischemic canine myocardium: implications for positron emission tomography. J Nucl Med 28:1322–1329

    Google Scholar 

  • Rose H, Hennecke T, Kammermeier H (1989) Is fatty acid uptake in cardiomyocytes determined by physicochemical fatty acid partition between albumin and membranes? Mol Cell Biochem 88:31–36

    Google Scholar 

  • Schad N, Wagner RK, Hallermeier J, Daus HJ, Vattimo A, Bertelli P (1990) Regional rates of myocardial fatty acid metabolism: comparison with coronary angiography and ventriculography. Eur J Nucl Med 16:205–212

    Google Scholar 

  • Schelbert HR, Henze E, Schön HR, Keen R, Hansen H, Selin C, Huang SC, Barrio JR, Phelps ME (1983) C-11 palmitate for the noninvasive evaluation of regional myocardial fatty acid metabolism with positron computed tomography. III. In vivo demonstration of the effects of substrate availability on myocardial metabolism. Am Heart J 105:492–504

    Google Scholar 

  • Schön HR, Schelbert HR, Robinson G, Najafi A, Huang SC, Hansen H, Barrio J, Kuhl DE, Phelps ME (1982) C-11 labeled palmitic acid for the noninvasive evaluation of regional myocardial fatty acid metabolism with positron-computed tomography. I. Kinetics of C-11 palmitic acid in normal myocardium. Am Heart J 103:532–547

    Google Scholar 

  • Strauss HW, Harrison K, Langan JK, Lebowitz E, Pitt B (1975) Thallium-201 for myocardial imaging. Relation of thallium-201 to regional myocardial perfusion. Circulation 51:641–645

    Google Scholar 

  • Stremmel W (1988) Fatty acid uptake by isolated rat heart myocytes represents a carrier-mediated transport process. J Clin Invest 81:844–852

    Google Scholar 

  • Ugolini V, Hansen CL, Kulkarni PV, Jansen DE, Akers MS, Corbett JR (1988) Abnormal myocardial fatty acid metabolism in dilated cardiomyopathy detected by iodine-123 phenylpentadecanoic acid and tomographic imaging. Am J Cardiol 62:923–928

    Google Scholar 

  • van der Vusse GJ, Glatz JF, Stam HCG (1989) Myocardial fatty acid homeostasis. Mol Cell Biochem 88:1–6

    Google Scholar 

  • van der Wall EE (1992) Assessment of myocardial metabolism with radiolabeled free fatty acids. In: van der Wall EE (ed) Nuclear cardiology and cardiac magnetic resonance. Hans Soto Productions, Weesp, The Netherlands, pp 25–44

    Google Scholar 

  • Vyska K, Machulla HJ, Stremmel W, Faßbender D, Knapp WH, Notohamiprodjo G, Gleichmann U, Meyer H, Knust EJ, Körfer R (1988) Regional myocardial free fatty acid extraction in normal and ischemic myocardium. Circulation 78:1218–1233

    Google Scholar 

  • Watson DD, Campbell NP, Read EK, Gibson RS, Teates CD, Beller GA (1981) Spatial and temporal quantitation of plane thallium myocardial images. J Nucl Med 22:577–584

    Google Scholar 

  • Weich HF, Strauss HW, Pitt B (1977) The extraction of thallium-201 by the myocardium. Circulation 56:188–191

    Google Scholar 

  • Westera G, van der Wall EE, Visser FC, Scholtabers AS, van Eenige MJ, Roos JP (1984) Myocardial uptake of iodinated free fatty acids and thallium-201 in experimental ischemia. Nucl Med 23:321–325

    Google Scholar 

  • Wolfe CL, Kennedy PL, Kulkarni PV, Jansen DE, Gabliani GI, Corbett JR (1990) Iodine-123 phenylpentadecanoic acid myocardial scintigraphy in patients with left ventricular hypertrophy: alterations in left ventricular distribution and utilization. Am Heart J 119:1338–1347

    Google Scholar 

  • Zimmer G, Zimmermann R, Hess OM, Schneider J, Kübler W, Krayenbühl HP, Hagl S, Mall G (1992) Myocyte degeneration and hypertrophy are independent structural determinants of impaired left ventricular function in patients with chronic heart diseases. A multiple logistic regression analysis. J Am Coll Cardiol

  • Zimmermann R, Tillmanns H, Knapp WH, Helus F, Georgi P, Rauch B, Neumann FJ, Girgensohn S, Maier-Borst W, Kübler W (1988a) Regional myocardial nitrogen-13 glutamate uptake in patients with coronary artery disease: inverse post-stress relation to thallium-201 uptake in ischemia. J Am Coll Cardiol 11:549–556

    Google Scholar 

  • Zimmermann R, Tillmanns H, Knapp WH, Neumann FJ, Saggau W, Kübler W (1988b) Noninvasive assessment of coronary artery bypass patency: determination of myocardial thallium-201 washout rates. Eur Heart J 9:319–327

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Ruprecht-Karls University, Heidelberg, Federal Republic of Germany

    Rainer Zimmermann, Bernhard Rauch, Michael Kapp, Franz-Josef Neumann, Friede Seitz, Per Stokstad & Wolfgang Kübler

  2. Department of Nuclear Medicine, Ruprecht-Karls University, Heidelberg, Federal Republic of Germany

    Bernd Bubeck

  3. Department of Pathology, Ruprecht-Karls University, Heidelberg, Federal Republic of Germany

    Gerhard Mall

  4. Department of Cardiology, University of Gießen, Gießen, Federal Republic of Germany

    Harald Tillmanns

Authors
  1. Rainer Zimmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernhard Rauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Kapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernd Bubeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Franz-Josef Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Friede Seitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Per Stokstad
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gerhard Mall
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Harald Tillmanns
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wolfgang Kübler
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study was supported by a grant from the Deutsche Forschungsgemeinschaft/Bonn within the SFB 320 “Herzfunktion und ihre Regulation”, Ruprechts-Karls University, Heidelberg

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zimmermann, R., Rauch, B., Kapp, M. et al. Myocardial scintigraphy with iodine-123 phenylpentadecanoic acid and thallium-201 in patients with coronary artery disease: a comparative dual-isotope study. Eur J Nucl Med 19, 946–954 (1992). https://doi.org/10.1007/BF00175860

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00175860

Key words

Search

Navigation