Experience with mild exercise ¹²³I-BMIPP myocardial imaging in two cases of ischemic heart disease

During mild to moderate ischemia, glycolytic flux is enhanced and free fatty acid uptake is reduced in proportion to the reduction in mitochondrial metabolism. We considered that mild exercise may induce the reduction of ¹²³I-BMIPP, reflecting myocardial fatty acid metabolism, in ischemic myocardium compared to normal myocardium. Therefore, mild exercise ¹²³I- BMIPP myocardial imaging was carried out to detect myocardial ischemia in 2 cases of ischemic heart disease. Mild exercise was performed using a bicycle ergometer with 25-50 W loading. At seven minutes before cessation of exercise, 111 MBq of ¹²³I-BMIPP was injected. Case 1 was a 12-year-old boy with Kawasaki's disease. The study showed a reduction of mild exercise ¹²³I-BMIPP uptake in the anteroseptal wall. In contrast, stress ²⁰¹Tl myocardial imaging did not show perfusion defect in the anteroseptal wall. Case 2 was a 64-year-old female with triple vessels disease. Mild exercise ¹²³I-BMIPP myocardial imaging showed similar with those of stress ^99mTc-sestamibi. We conclude that mild exercise ¹²³I-BMIPP myocardial SPECT may be a sensitive method to detect myocardial ischemia.