Abstract
A 57-year-old male with a 20-yr history of NIDDM and hypertension underwent dipyridamol-infusion (0.14mg/kg/min) thallium-201 scintigraphy to assess the possible presence of coronary artery disease, as the patient had demonstrated ischemic ST-T change on electrocardiogram. Dipyridamole-infusion thallium-201 scintigraphy showed transient perfusion defects in the infero-posterior wall of the left ventricle. Contrast left ventriculography showed reduced wall motion in the infero-posterior wall of the left ventricule despite normal coronary arteries documented by coronary arteriography. Myocardial SPECT imaging with thallium-201 and I-123 beta-methylp-iodophenyl pentadecanoicacid (BMIPP) revealed reduced I-123 BMIPP uptake compared with thallium-201 uptake in the infero-posterior wall, suggesting the impairment of myocardial free fatty acid metabolism in the regions with wall motion abnormality. These results suggest that small vessel disease and the impairment of myocardial free fatty acid metabolism are etiologic or contributory factors in regional wall motion abnormarity.
