Iodine-123 phenylpentadecanoic acid and single photon emission computed tomography in identifying left ventricular regional metabolic abnormalities in patients with coronary heart disease: Comparison with thallium-201 myocardial tomography

Christopher L. Hansen, James R. Corbett, John J. Pippin, Donald E. Jansen, Padmaker V. Kulkarni, Valentina Ugolini, Eugene Henderson, Marvin Akers, L. Maximilian Buja, Robert W. Parkey, James T. Willerson

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Abstract

Iodine-123 phenylpentadecanoic acid (IPPA) is a synthetic long chain fatty acid with myocardial kinetics similar to palmitate. Two hypotheses were tested in this study. The first hypothesis was that IPPA imaging with single photon emission computed tomography (SPECT) is useful in the identification of patients with coronary artery disease. Fourteen normal volunteers (aged 27 ± 2 years) and 33 patients (aged 54 ± 11 years) with stable symptomatic coronary artery disease and at least one major coronary artery with luminal diameter narrowing ≥70% were studied with symptom-limited maximal exercise testing. The IPPA (6 to 8 mCi) was injected 1 min before the termination of exercise, and tomographic imaging was performed beginning at 9 min and repeated at 40 min after the injection of IPPA. Nine of the normal volunteers and 13 of the patients had a second examination performed at rest on another day. Using the limits of normal as 2 SD from the normal mean values, 27 of the 33 patients with coronary artery disease demonstrated abnormalities in either the initial distribution or the clearance of IPPA, or both. Nineteen of the 33 patients had a maximal variation of activity distribution of ≥ 25% on the 9 min IPPA images. Twenty-two of the 33 patients had a maximal variation in IPPA washout >17% and 17 had a washout rate ≤2%. There was good agreement between the location of significant coronary artery stenoses and abnormalities in the initial distribution and clearance of IPPA. The second hypothesis tested was that IPPA imaging is as or more sensitive and, therefore, complementary to thallium-201 imaging in the identification of exercise-induced ischemia in patients. Twenty-five of the 33 patients underwent both thallium-201 and IPPA tomographic imaging after symptom-limited maximal exercise testing. The amount of exercise performed by each patient during both studies was shnilar. Twenty-one of the 25 patients had abnormal IPPA tomographic studies, whereas 18 had abnormal thallium-201 tomographic studies (p = NS). The results of this study suggest the following conclusions: 1) iodine-123 phenylpentadecanoic acid imaging using single photon emission computed tomography and exercise provides a sensitive and relatively noninvasive method for identifying abnormalities in myocardial metabolism associated with significant coronary artery stenoses, and 2) iodine-123 phenylpentadecanoic acid is at least as sensitive as thallium-201 for this purpose using tomographic imaging and exercise testing.

Original languageEnglish (US)
Pages (from-to)78-87
Number of pages10
JournalJournal of the American College of Cardiology
Volume12
Issue number1
DOIs
StatePublished - 1988

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Thallium
Single-Photon Emission-Computed Tomography
Iodine
Coronary Disease
Tomography
Acids
Exercise
Coronary Artery Disease
Coronary Stenosis
Healthy Volunteers
Palmitates
Coronary Vessels
Reference Values
Fatty Acids
Ischemia

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Iodine-123 phenylpentadecanoic acid and single photon emission computed tomography in identifying left ventricular regional metabolic abnormalities in patients with coronary heart disease : Comparison with thallium-201 myocardial tomography. / Hansen, Christopher L.; Corbett, James R.; Pippin, John J.; Jansen, Donald E.; Kulkarni, Padmaker V.; Ugolini, Valentina; Henderson, Eugene; Akers, Marvin; Buja, L. Maximilian; Parkey, Robert W.; Willerson, James T.

In: Journal of the American College of Cardiology, Vol. 12, No. 1, 1988, p. 78-87.

Research output: Contribution to journalArticle

Hansen, Christopher L. ; Corbett, James R. ; Pippin, John J. ; Jansen, Donald E. ; Kulkarni, Padmaker V. ; Ugolini, Valentina ; Henderson, Eugene ; Akers, Marvin ; Buja, L. Maximilian ; Parkey, Robert W. ; Willerson, James T. / Iodine-123 phenylpentadecanoic acid and single photon emission computed tomography in identifying left ventricular regional metabolic abnormalities in patients with coronary heart disease : Comparison with thallium-201 myocardial tomography. In: Journal of the American College of Cardiology. 1988 ; Vol. 12, No. 1. pp. 78-87.
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abstract = "Iodine-123 phenylpentadecanoic acid (IPPA) is a synthetic long chain fatty acid with myocardial kinetics similar to palmitate. Two hypotheses were tested in this study. The first hypothesis was that IPPA imaging with single photon emission computed tomography (SPECT) is useful in the identification of patients with coronary artery disease. Fourteen normal volunteers (aged 27 ± 2 years) and 33 patients (aged 54 ± 11 years) with stable symptomatic coronary artery disease and at least one major coronary artery with luminal diameter narrowing ≥70{\%} were studied with symptom-limited maximal exercise testing. The IPPA (6 to 8 mCi) was injected 1 min before the termination of exercise, and tomographic imaging was performed beginning at 9 min and repeated at 40 min after the injection of IPPA. Nine of the normal volunteers and 13 of the patients had a second examination performed at rest on another day. Using the limits of normal as 2 SD from the normal mean values, 27 of the 33 patients with coronary artery disease demonstrated abnormalities in either the initial distribution or the clearance of IPPA, or both. Nineteen of the 33 patients had a maximal variation of activity distribution of ≥ 25{\%} on the 9 min IPPA images. Twenty-two of the 33 patients had a maximal variation in IPPA washout >17{\%} and 17 had a washout rate ≤2{\%}. There was good agreement between the location of significant coronary artery stenoses and abnormalities in the initial distribution and clearance of IPPA. The second hypothesis tested was that IPPA imaging is as or more sensitive and, therefore, complementary to thallium-201 imaging in the identification of exercise-induced ischemia in patients. Twenty-five of the 33 patients underwent both thallium-201 and IPPA tomographic imaging after symptom-limited maximal exercise testing. The amount of exercise performed by each patient during both studies was shnilar. Twenty-one of the 25 patients had abnormal IPPA tomographic studies, whereas 18 had abnormal thallium-201 tomographic studies (p = NS). The results of this study suggest the following conclusions: 1) iodine-123 phenylpentadecanoic acid imaging using single photon emission computed tomography and exercise provides a sensitive and relatively noninvasive method for identifying abnormalities in myocardial metabolism associated with significant coronary artery stenoses, and 2) iodine-123 phenylpentadecanoic acid is at least as sensitive as thallium-201 for this purpose using tomographic imaging and exercise testing.",
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T1 - Iodine-123 phenylpentadecanoic acid and single photon emission computed tomography in identifying left ventricular regional metabolic abnormalities in patients with coronary heart disease

T2 - Comparison with thallium-201 myocardial tomography

AU - Hansen, Christopher L.

AU - Corbett, James R.

AU - Pippin, John J.

AU - Jansen, Donald E.

AU - Kulkarni, Padmaker V.

AU - Ugolini, Valentina

AU - Henderson, Eugene

AU - Akers, Marvin

AU - Buja, L. Maximilian

AU - Parkey, Robert W.

AU - Willerson, James T.

PY - 1988

Y1 - 1988

N2 - Iodine-123 phenylpentadecanoic acid (IPPA) is a synthetic long chain fatty acid with myocardial kinetics similar to palmitate. Two hypotheses were tested in this study. The first hypothesis was that IPPA imaging with single photon emission computed tomography (SPECT) is useful in the identification of patients with coronary artery disease. Fourteen normal volunteers (aged 27 ± 2 years) and 33 patients (aged 54 ± 11 years) with stable symptomatic coronary artery disease and at least one major coronary artery with luminal diameter narrowing ≥70% were studied with symptom-limited maximal exercise testing. The IPPA (6 to 8 mCi) was injected 1 min before the termination of exercise, and tomographic imaging was performed beginning at 9 min and repeated at 40 min after the injection of IPPA. Nine of the normal volunteers and 13 of the patients had a second examination performed at rest on another day. Using the limits of normal as 2 SD from the normal mean values, 27 of the 33 patients with coronary artery disease demonstrated abnormalities in either the initial distribution or the clearance of IPPA, or both. Nineteen of the 33 patients had a maximal variation of activity distribution of ≥ 25% on the 9 min IPPA images. Twenty-two of the 33 patients had a maximal variation in IPPA washout >17% and 17 had a washout rate ≤2%. There was good agreement between the location of significant coronary artery stenoses and abnormalities in the initial distribution and clearance of IPPA. The second hypothesis tested was that IPPA imaging is as or more sensitive and, therefore, complementary to thallium-201 imaging in the identification of exercise-induced ischemia in patients. Twenty-five of the 33 patients underwent both thallium-201 and IPPA tomographic imaging after symptom-limited maximal exercise testing. The amount of exercise performed by each patient during both studies was shnilar. Twenty-one of the 25 patients had abnormal IPPA tomographic studies, whereas 18 had abnormal thallium-201 tomographic studies (p = NS). The results of this study suggest the following conclusions: 1) iodine-123 phenylpentadecanoic acid imaging using single photon emission computed tomography and exercise provides a sensitive and relatively noninvasive method for identifying abnormalities in myocardial metabolism associated with significant coronary artery stenoses, and 2) iodine-123 phenylpentadecanoic acid is at least as sensitive as thallium-201 for this purpose using tomographic imaging and exercise testing.

AB - Iodine-123 phenylpentadecanoic acid (IPPA) is a synthetic long chain fatty acid with myocardial kinetics similar to palmitate. Two hypotheses were tested in this study. The first hypothesis was that IPPA imaging with single photon emission computed tomography (SPECT) is useful in the identification of patients with coronary artery disease. Fourteen normal volunteers (aged 27 ± 2 years) and 33 patients (aged 54 ± 11 years) with stable symptomatic coronary artery disease and at least one major coronary artery with luminal diameter narrowing ≥70% were studied with symptom-limited maximal exercise testing. The IPPA (6 to 8 mCi) was injected 1 min before the termination of exercise, and tomographic imaging was performed beginning at 9 min and repeated at 40 min after the injection of IPPA. Nine of the normal volunteers and 13 of the patients had a second examination performed at rest on another day. Using the limits of normal as 2 SD from the normal mean values, 27 of the 33 patients with coronary artery disease demonstrated abnormalities in either the initial distribution or the clearance of IPPA, or both. Nineteen of the 33 patients had a maximal variation of activity distribution of ≥ 25% on the 9 min IPPA images. Twenty-two of the 33 patients had a maximal variation in IPPA washout >17% and 17 had a washout rate ≤2%. There was good agreement between the location of significant coronary artery stenoses and abnormalities in the initial distribution and clearance of IPPA. The second hypothesis tested was that IPPA imaging is as or more sensitive and, therefore, complementary to thallium-201 imaging in the identification of exercise-induced ischemia in patients. Twenty-five of the 33 patients underwent both thallium-201 and IPPA tomographic imaging after symptom-limited maximal exercise testing. The amount of exercise performed by each patient during both studies was shnilar. Twenty-one of the 25 patients had abnormal IPPA tomographic studies, whereas 18 had abnormal thallium-201 tomographic studies (p = NS). The results of this study suggest the following conclusions: 1) iodine-123 phenylpentadecanoic acid imaging using single photon emission computed tomography and exercise provides a sensitive and relatively noninvasive method for identifying abnormalities in myocardial metabolism associated with significant coronary artery stenoses, and 2) iodine-123 phenylpentadecanoic acid is at least as sensitive as thallium-201 for this purpose using tomographic imaging and exercise testing.

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