Imaging of myocardial fatty acid metabolism using ¹²³I-betamethyl-p-iodophenyl-pentadecanoic acid (¹²³I-BMIPP) SPECT is useful for identifying high-risk patients with known ischemic heart disease. However, its utility for patients who have nonischemic heart failure with preserved ejection fraction is not well known. This study aimed to evaluate the prognostic value of the ¹²³I-BMIPP defect score in such patients. Methods: Of 804 consecutive patients who were admitted to the hospital because of acute heart failure and underwent ¹²³I-BMIPP SPECT, we identified 133 (mean age ± SD, 73 ± 13 y) who had normal coronary arteries by invasive coronary angiography and preserved left ventricular ejection fraction (≥50%) by echocardiography. ¹²³I-BMIPP defects were quantitatively scored to obtain summed defect scores in 17 segments of ¹²³I-BMIPP SPECT images. The patients were divided into 2 groups based on their score. The multivariate Cox model was used to assess a possible correlation between a higher score (≥4, n = 46) and major adverse cardiac events, including cardiac death, cardiovascular events, and hospitalization for heart failure, compared with a lower score (<4, n = 87). Results: During a mean follow-up of 2.5 y, 35 major adverse cardiac events occurred. The median scores in the high-score and low-score groups were 7.13 ± 4.21 and 1.29 ± 0.80, respectively. By multivariate Cox analysis, a higher score was associated with increased major adverse cardiac events, compared with a lower score (hazard ratio, 11.04; 95% confidence interval, 4.93–24.74; P < 0.001). Conclusion: This study demonstrated that the defect score by ¹²³I-BMIPP SPECT may have potential prognostic value in patients who have nonischemic heart failure with preserved ejection fraction.

使用心肌脂肪酸代谢的成像¹²³ I-betamethyl- p碘苯基-十五烷酸（¹²³ I-BMIPP）SPECT是用于识别高风险患者的已知缺血性心脏疾病是有用的。然而，其对于具有非射血分数保留的非缺血性心力衰竭患者的效用尚不为人所知。这项研究旨在评估¹²³ I-BMIPP缺损评分在此类患者中的预后价值。方法：连续804例因急性心力衰竭入院并接受了¹²³例治疗的患者通过I-BMIPP SPECT，我们通过侵入性冠状动脉造影确定了133例（平均年龄±SD，73±13 y）具有正常冠状动脉，并通过超声心动图检查保留了左心室射血分数（≥50％）。^对123个I-BMIPP缺陷进行定量评分，以获得^123个I-BMIPP SPECT图像的17个片段中的总缺陷评分。根据得分将患者分为2组。多元Cox模型用于评估较高分数（≥4，n = 46）与主要不良心脏事件（包括心脏死亡，心血管事件和心力衰竭住院）之间的可能相关性，而较低分数（<4 ，n = 87）。结果：在平均随访2.5年中，发生了35次主要的不良心脏事件。高分和低分组的中位数分别为7.13±4.21和1.29±0.80。通过多变量Cox分析，较高的分数与严重的不良心脏事件增加相关，而较低的分数（危险比，11.04； 95％置信区间，4.93-24.74；P <0.001）。结论：这项研究表明，¹²³ I-BMIPP SPECT的缺损评分可能对具有非射血分数的非缺血性心力衰竭患者具有潜在的预后价值。