Abstract: Fatty acid metabolism is the most efficient mode of myocardial energy production. Alter- ation of fatty acid metabolism is considered to be a sensitive marker of ischaemia and myocardial damage. After myocardial ischemia, prolonged suppression of fatty acid metabolism may persist despite restoration of blood flow, which is called metabolic stunning or ischemia memory. Assessment of fatty acid metabolism by radionu-clide labeled β-methyl-p-iodophenyl pentadecanoic acid(BMIPP) SPECT plays a potential role in the early detection of myocardial ischaemia and the assessment of the severity of ischaemic coronary artery disease and myocardial disease. This article describes recent advances in ¹²³I-BMIPP myocardial imaging.