2020 Volume 84 Issue 10 Pages 1886-
Two cases of low cardiac perfusion in patients with systemic sclerosis (SSc) diagnosed by 123I-β-methyl iodophenyl pentadecanoic acid (BMIPP) and 201thallium dual myocardial single-photon emission computed tomography (BMIPP/Tl SPECT) are described.
Patient 1 was a 62-year-old-Japanese woman who presented with exertional dyspnea. She had been diagnosed with SSc 1 year before and was treated with prednisolone (5 mg/day) and mizoribine (150 mg/day) without any change on ECG. Admission ECG was normal, and transthoracic echocardiography (TTE) demonstrated only mild ventricular septal defect. N terminal-pro B-type natriuretic peptide (NT-proBNP) was 203 pg/mL. BMIPP and BMIPP/Tl SPECT demonstrated mild low perfusion in the anteroseptal and inferior walls of the left ventricle (LV) with only minimal mismatch with BMIPP (Figure A,B, arrows). Nicorandil (15 mg/day), an adenosine triphosphate-sensitive potassium channel opener, was prescribed, and her symptom disappeared. When measured again 4 months later, NT-proBNP had decreased (56.7 pg/mL), and BMIPP/Tl SPECT revealed partial improvement of low uptake/perfusion, especially on the BMIPP image (Figure C,D, arrows).
(A,C,E,G) 123I-β-methyl iodophenyl pentadecanoic acid (BMIPP) and (B,D,F,H) 201thallium (Tl) dual myocardial single-photon emission computed tomography images for patients 1 and 2.
Patient 2 was a 69-year-old-Japanese woman admitted for chest pain. She had been diagnosed with SSc 14 years before, and treated with beraprost (40 μg/day). Admission ECG and TTE were normal, and NT-proBNP was 152.6 pg/mL. Coronary angiography was normal. BMIPP/Tl SPECT demonstrated mild low perfusion in the anteroseptal wall and apex of the LV with mismatch with BMIPP (lower uptake than Tl) (Figure E,F, arrows). Nicorandil (15 mg/day) was prescribed, and her chest pain disappeared; 7 months later, NT-proBNP was 135.1 pg/mL and BMIPP/Tl SPECT revealed mild improvement of low perfusion on Tl image and improvement of septal uptake on BMIPP images. Post-treatment images with both modalities looked more homogenous than the pre-therapeutic images (Figure G,H, arrows).
BMIPP/Tl SPECT may be useful to detect impaired myocardial fatty acid metabolism related to coronary microvascular dysfunction in SSc.
K.M. is a member of Circulation Journal’ Editorial Team. The authors state that they have no conflicts of interest.
