A Case of Hypertensive-Diabetic Cardiomyopathy Demonstrating Left Ventricular Wall Motion Abnormality

We report a case of hypertensive-diabetic cardiomyopathy demonstrating left ventricular regional wall motion abnormality, with a normal coronary artery documented on coronary arteriography. Dipyridamole-infusion ²⁰¹Tl scintigraphy demonstrated transient perfusion defects in the infero-posterior wall of the left ventricle, where reduced wall motion was demonstrated on contrast left ventriculography. Myocardial SPECT (single photon emission tomography) imaging with [¹²³I] β-methyliodophenylpentadecanoic acid (BMIPP) and ²⁰¹Tl demonstrated reduced [¹²³I]BMIPP uptake compared with ²⁰¹Tl uptake in the infero-posterior wall of left ventricle. These results suggest that the impairment of myocardial free fatty acid metabolism is an etiologic or contributory factor for regional wall motion abnormality, together with small-vessel coronary artery disease, in this patient.