Evaluation of Right Ventricular overload by ^<123>I-MIBG, ^<123>I-BMIPP , and ^<99m>Tc-MIBI

It is important to evaluate the severity of right ventricular (RV) overload in patients with chronic pulmonary diseases or pulmonary thromboembolism because their prognosis depend on the severity of RV overload. Various examination methods have been used to non-invasively evaluate the severity of RV overload. We evaluated the usefulness of recently developed novel radiopharmaceuticals 123I-MIBG, 123I-BMIPP, and 99mTc-MIBI) in patients with chronic respiratory diseases or pulmonary thromboembolism. Myocardial scintigraphy using 1231-MIBG revealed that the ratio of scintillation counts in the interventricular septum (IVS) to those in the left ventricle (LV) correlated negatively with the mean pulmonary arterial pressure (MPAP), suggesting the presence of sympathetic neuropathy due to RV overload. Myocardial scintigraphy using 123I-BMIPP revealed that the ratio of scintillation counts in the RV to those in LV (RV/LV uptake ratio) correlated with MPAP. There was a negative correlation between RV metabolic index [RVMI = (RV/LV ratio of 123I-BMIPP uptake)(RV/LV ratio of 201T1 uptake)] and MPAP. These findings suggested the presence of RV overload-induced fatty acid metabolic disorder. 99iTc-MIBI allows the simultaneous performance of both cardiac pool scintigraphy and myocardial single photon emission computed tomography. RV/LV ratio of 99Tc-MIBI uptake correlated with MPAP. Moreover, RV ejection fraction (RVEF) obtained by right cardiac pool scintigraphy correlated with the RVEF determined by the thermodilution method, suggesting the usefulness of 99mTc-MIBI. Our findings suggest that these radiopharmaceuticals are useful for evaluating the severity of RV overload in patients with chronic respiratory diseases or pulmonary thromboembolism, as well as for evaluating RV overloadinduced metabolic disorders