Diagnostic significance of positive I-123 BMIPP despite negative stress Tl-201 myocardial imaging in patients with suspected coronary artery disease

There is frequently discordance in the interpretation of myocardial single-photon emission computed tomography images using both rest iodine-123 15-(p-iodophenyl)-3-(R, S) methylpentadecanoic acid (BMIPP) and stress thallium-201 (201Tl); that is, negative BMIPP vs positive 201Tl studies. However, little attention has been paid to reverse discordance (ie, positive BMIPP despite negative stress 201Tl). In the present study 105 consecutive patients with suspected coronary artery disease (CAD) who underwent both rest BMIPP and stress 201Tl imaging were evaluated. No patient with previous myocardial infarction was included. Scintigraphic studies revealed that BMIPP was in concordance with 201Tl in 71 patients: both were positive in 38 and negative in 33, whereas both were discordant in 20 and reverse discordant in 14. In patients with reverse discordance, the pattern of BMIPP abnormality was segmental in 8 and spotty in 6; the former was related to coronary territory. Based on the BMIPP findings and clinical symptoms, 7 patients with positive BMIPP despite negative 201Tl underwent coronary angiography: 3-vessel CAD was found in 3 patients, 2-vessel CAD in 1, coronary spasm in 2, and insignificant lesions in 1. In the remaining 7 patients, no cardiac event was observed during 2-year follow-up. In patients showing positive BMIPP despite negative 201Tl, a segmental BMIPP perfusion abnormality indicates a high likelihood for CAD, despite normal stress 201Tl imaging. Thus, adding BMIPP to 201Tl imaging may help to better identify patients with significant CAD, including multivessel disease. (author)