Scintigraphic Evaluation of Cardiac Metabolism and Sympathetic Nerve Function in Alcoholic Cardiomyopathy

Abstract

A 70-year-old man with alcoholic cardiomyopathy underwent ^99mtechnetium-sestamibi (MIBI), iodine-123-labeled metaiodobenzylguanidine (MIBG) scintigraphy and Iodine-123-labeled beta-methyl-iodophenyl pentadecanoic acid (BMIPP) scintigraphy. ^99mTechnetium-MIBI identified myocardial damage in the inferior wall of left ventricle. ¹²³I BMIPP showed low uptake in the inferior wall of the myocardium, concordant to perfusion. ¹²³I BMIPP and ¹²³I MIBG showed reduced uptake in the inferior segment of the myocardium, indicating impairment of fatty acid metabolism and sympathetic abnormalities. Damaged myocardium was demonstrated in alcoholic cardiomyopathy. Beta blocker (carvedilol) and angiotensin-receptor blocker (valsartan) were started at low doses, then increased gradually, leading to the improvement of cardiac performance. Cardiac sympathetic nerve function, impaired due to alcoholic cardiomyopathy, was improved with beta-blocker therapy. Cardiac scintigraphy may be useful to assess the extent of myocardial improvement and the response to therapy.