Delayed metabolic recovery of hibernating myocardium after percutaneous transluminal coronary angioplasty. Assessment with iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid imaging

The time course of improvement in fatty acid metabolism after percutaneous transluminal coronary angioplasty (PTCA) was investigated using echocardiography and fatty acid metabolic imaging with iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) before, 1 week and 3 months after PTCA in 31 patients with angina pectoris. Decreased left ventricular wall motion before PTCA improved 1 week after PTCA in 13 of 31 patients. 123I-BMIPP uptake was reduced in these 13 patients before PTCA, and did not improve 1 week after PTCA. Decreased myocardial uptake of 123I-BMIPP improved 1 week after PTCA in eight of 23 patients (group A). Thirteen patients in whom 123I-BMIPP uptake had not improved 1 week after PTCA showed a delayed recovery of 3 months after PTCA (group B). All patients in groups A and B showed improvement in wall motion 1 week after PTCA. Patients in group B had a higher incidence of unstable angina (77% vs 25%, p<0.01), 99% or 100% stenosis (62% vs 13%, p<0.01) and collateral vessels (46% vs 13%, p<0.05) than those in group A. Serial fatty acid metabolic imaging with 123I-BMIPP after PTCA showed delayed metabolic recovery after improvement in wall motion in 13 of 23 patients. The presence of severe myocardial ischemia before PTCA enhanced the chronological discrepancies between the recovery of wall motion and fatty acid metabolism. (author)