***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract . Previous studies have indicated that iodine-123 labelled β-methyliodophenyl pentadecanoic acid ( BMI PP ) , an iodinated fatty acid analogue , can identify persistent alteration of fatty acid metabolism after restoration of blood flow . To assess whether fatty acid imaging can delineate areas at risk following successful revascularization in patients with acute myocardial infa rct ion ( AMI ) , BMI PP findings at 1 week post AMI were compared with perfusion imaging before and after revascularization therapy . Sixty-five patients with AMI underwent technetium-99 m tetrofosmin single-photon emission tomography ( SPET ) before m ( TF0 ) and 1 week ( TF1 ) after successful revascularization therapy . BMI PP SPET was also performed under a fasting state at 1 week ( BM1 ) post AMI . The extent scores were calculated from the defect scores in 20 segments . The BM1 score ( 7.7±3.9 ) was similar to the TF0 score ( 8.8±4.2 ) ( r=0.86 , P<0.0001 ) , but significantly higher than the TF1 score ( 5.8±3.9 ) ( P<0.0001 ) . A significant correlation was observed between the BM1 score and TF0 score ( r=0.86 , P<0.0001 ) . Among a total of 1300 segments , the BM1 score was identical to the TF0 score in 1156 ( 88.9 % ) . These data indicate that the ability of BMI PP imaging at 1 week post AMI to identify areas at risk is similar to that of tetrofosmin perfusion imaging in the acute phase . This may be due to the impairment of fatty acid uptake and metabolism reflecting prior severe ischaemic insult which persists at least 1 week after recovery of perfusion in the acute phase of AMI Purpose It is unclear whether 123I-labelled β-methyl iodophenyl pentadecanoic acid ( 123I- BMI PP ) myocardial scintigraphy adds further predictive value for future cardiac events compared with the variables obtained during cardiac catheterisation in patients with acute myocardial infa rct ion ( AMI ) treated with primary percutaneous coronary intervention ( PCI ) . We therefore investigated whether 123I- BMI PP imaging in patients with AMI treated by primary PCI was useful in predicting future cardiac events . Methods One hundred and fifty-nine patients with AMI who were treated with primary PCI and underwent left ventriculography ( LVG ) on admission underwent 201Tl and 123I- BMI PP myocardial scintigraphy .  Scintigrams were visually classified , and the total defect score ( TDS ) was calculated . Major adverse cardiac events ( MACE ) were defined as cardiac death including sudden death , congestive heart failure and recurrence of acute coronary syndrome . Patients were followed up for a mean of 34.5 months ( 12–63 months ) . Results Twenty-six patients had MACE . Kaplan-Meier analysis indicated that patients with the top 50 % of 123I- BMI PP TDSs had a significantly higher rate of MACE ( P=0.007 ) . Patients with mismatch between 201Tl and 123I- BMI PP images also had significantly more MACE ( P=0.02 ) . In the prediction of MACE , the global chi-square value was 5.2 ( P=0.001 ) based on LVEF ( < 45 % ) and the number of diseased vessels ( two or three ) . Adding 123I- BMI PP TDS and the mismatch improved the global chi-square value ( χ2=7.2 ) Conclusion Myocardial scintigraphy using 201Tl and 123I- BMI PP predicts future cardiac events in patients with AMI treated with primary PCI , and provides additional predictive value compared with the variables obtained with cardiac catheterisation alone Impaired cardiac fatty acid uptake , assessed by the radiolabelled fatty acid analogue β-methyl-p-iodophenyl pentadecanoic acid ( I-123- BMI PP ) , is observed in the myocardium following acute ischaemic events , but the long-term prognostic implication has not been established . This study aim ed to determine the prognostic value of cardiac BMI PP uptake in patients with acute myocardial infa rct ion . Following the assessment of thallium-201 and I-123- BMI PP uptake , 101 post-infa rct patients were prospect ively followed up with primary end points of cardiac death , heart failure and non-fatal infa rct ion . During a mean follow-up of 28 months , three cardiac deaths , three non-fatal infa rct ions , 23 revascularizations and four recurrences of angina pectoris were observed . Multivariate analysis identified reduced uptake of BMI PP and perfusion , no β-blocking treatment and greater thallium- BMI PP mismatch ( i.e. larger BMI PP defect than thallium defect ) as significant predictors for overall cardiac events . Prior myocardial infa rct ion , reduced left ventricular ejection fraction and greater thallium- BMI PP mismatch were selected as independent predictors of harder cardiac events . Female patients , those with greater BMI PP defect or greater thallium- BMI PP mismatch showed worse clinical outcomes . The inclusion of BMI PP data improved the prognostic values of conventional significant predictors . In conclusion , impaired myocardial I-123- BMI PP uptake and perfusion- BMI PP mismatch are related to a high probability of fatal and non-fatal cardiac events , suggesting the aetiological relevance and prognostic value of impaired cardiac fatty acid metabolism in viable , but jeopardized , myocardium following acute myocardial infa rct ion A fatty acid analogue , 123I-labelled β-methyl iodophenyl pentadecanoic acid ( BMI PP ) , has been used to identify ischaemic and metabolically impaired myocardium . However , the prognostic value of BMI PP imaging , particularly in relation to stress myocardial perfusion imaging , remains unclear . Data from 167 consecutive patients with angina pectoris but without prior myocardial infa rct ion ( MI ) who had undergone both BMI PP and stress 201Tl ( sTL ) imaging  were analysed . Tracer uptake was grade d using a 13-segment , 4-point scoring model . Patients were followed up for 48 months with primary end points ( cardiac death , non-fatal MI ) as hard cardiac events and with secondary end points ( late revascularisation , recurrent angina and heart failure ) as soft events . For overall cardiac events ( 5 hard and 29 soft events ) , Kaplan-Meier analysis revealed significantly lower event rates in subgroups with normal BMI PP uptake , a summed difference score of sTL ( SDS ) of <3 or absence of diabetes mellitus when compared to each counterpart . Multivariate Cox ’s analysis revealed reduced BMI PP uptake , SDS ≥3 , diabetes and reduced ejection fraction to be significant predictors . Negative predictive values of normal BMI PP and SDS <3 for all events were 91 % and 84 % , respectively . No hard event occurred in 66 patients with normal BMI PP uptake , whereas two patients with SDS <3 but impaired BMI PP uptake had hard events . In conclusion , normal BMI PP imaging is an excellent prognostic sign , independently of stress myocardial perfusion imaging , in patients with angina pectoris without prior MI We prospect ively evaluated if impaired myocardial fatty acid metabolism is involved in cardiac death after revascularization by percutaneous coronary artery intervention in dialysis patients . A cohort of hemodialysis patients was assessed by dual single-photon emission computed tomography using the radioiodinated fatty acid analogue BMI PP and radiolabeled thallium chloride . Tomography was done within one month before the first coronary intervention and at the last follow-up angiography at which neither restenosis nor de novo lesions were detected . Radiolabel uptake on tomography images was grade d in segments and calculated as summed BMI PP or thallium scores . Among the 90 hemodialysis patients in the study , 19 died of cardiac events . Multivariate Cox hazard analysis found a significant association of cardiac death with the BMI PP summed scores at the last follow-up angiography . Kaplan-Meier analysis showed the cardiac death-free survival rates at 3 years of follow-up were significantly higher in patients with lower BMI PP summed scores . These results suggest that myocardial fatty acid imaging may be a useful test to identify high risk groups of cardiac death in hemodialysis patients 
    Output:
    
The prognostic value of perfusion-metabolism mismatch compared with myocardial perfusion imaging was dependent upon the relative timing of BMI PP imaging , revascularization , and myocardial perfusion damage .
Conclusions BMI PP imaging is useful for the risk stratification of patients with coronary artery disease , particularly patients with acute chest pain