Absence of Myocardial ¹²³I-BMIPP Uptake in the Presence of a Normal Coronary Angiogram and Normokinetics on a Left Ventriculogram

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We present the case of a 44-year-old man with abnormal myocardial fatty acid metabolism who exhibited no myocardial uptake of ¹²³I-β-methyl- iodophenyl pentadecanoic acid (¹²³I-BMIPP). This patient presented to our hospital with an ECG abnormality detected during a medical check-up. He felt no chest discomfort, but a 12-lead ECG at rest showed flat T-waves in leads I, V5, and V6 with no marked ischemic changes during exercise. A left ventriculogram and coronary angiograms were normal. Thallium-201 single photon emission computed tomography imaging revealed a normal myocardial uptake, but ¹²³I-BMIPP imaging showed no such uptake. However, ¹⁸F-labelled fluorodeoxyglucose positron emission tomography imaging after an over-night fast showed a marked increase in myocardial uptake. It appears that myocardial uptake of ¹²³I-BMIPP was totally lacking and that energy production by the myocardium during fasting depended on the metabolism of glucose rather than of fatty acids. (Jpn Circ J 1997; 61: 263-267)