Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging
Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging Masato Nishimura, Kazumasa Tsukamoto, Naoyuki Hasebe, Nagara Tamaki, Kenjiro Kikuchi, Toshihiko Ono This prospective cohort study showed that the occurrence of cardiac death among patients on maintenance hemodialys...
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Published in | Journal of the American College of Cardiology Vol. 51; no. 2; pp. 139 - 145 |
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Language | English |
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15.01.2008
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Abstract | Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging Masato Nishimura, Kazumasa Tsukamoto, Naoyuki Hasebe, Nagara Tamaki, Kenjiro Kikuchi, Toshihiko Ono This prospective cohort study showed that the occurrence of cardiac death among patients on maintenance hemodialysis is closely associated with severely abnormal β-methyl iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography images. Kaplan-Meier survival estimates showed that survival rates worsened with an increasing summed BMIPP score. Highly impaired myocardial fatty acid metabolism can identify groups of hemodialysis patients at high risk for cardiac death. |
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AbstractList | The aim was to evaluate the potential of single-photon emission computed tomography (SPECT) to predict cardiac death in chronic hemodialysis patients using the iodinated fatty acid analogue iodine-123 123I-beta-methyl iodophenyl-pentadecanoic acid (BMIPP).
We previously reported that BMIPP SPECT could detect asymptomatic coronary artery disease with high sensitivity in hemodialysis patients.
We prospectively enrolled 375 asymptomatic hemodialysis patients who had undergone dual SPECT using 123I-BMIPP and 201thallium (Tl) chloride. Patients who had a clinical history of myocardial infarction and/or coronary revascularization were excluded from the study. Uptake on SPECT images was graded in 17 segments on a 5-point scale (0 normal, 4 absent) and assessed as summed BMIPP or Tl scores.
During a 3.6 +/- 1.0-year follow-up, 57 patients who had undergone coronary revascularization within 60 days of SPECT were excluded from the analysis. Among the remaining 318 patients (male/female: 170/148; 64 +/- 12 years of age), 50 died of cardiac events (acute myocardial infarction 22, congestive heart failure 17, cardiac sudden death 11). Stepwise Cox hazard analysis associated cardiac death with age (> or =70 years) and with severely abnormal BMIPP SPECT images (BMIPP summed scores > or =12: hazard ratio 21.894; p < 0.0001). Kaplan-Meier analysis showed that the cardiac death-free survival rates at 3 years were 61% and 98% in patients with BMIPP summed scores of > or =12 and <12, respectively.
Severely impaired myocardial fatty acid metabolism, which might mainly reflect repetitive myocardial ischemia, can identify a high-risk group of cardiac death among hemodialysis patients. Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging Masato Nishimura, Kazumasa Tsukamoto, Naoyuki Hasebe, Nagara Tamaki, Kenjiro Kikuchi, Toshihiko Ono This prospective cohort study showed that the occurrence of cardiac death among patients on maintenance hemodialysis is closely associated with severely abnormal β-methyl iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography images. Kaplan-Meier survival estimates showed that survival rates worsened with an increasing summed BMIPP score. Highly impaired myocardial fatty acid metabolism can identify groups of hemodialysis patients at high risk for cardiac death. OBJECTIVESThe aim was to evaluate the potential of single-photon emission computed tomography (SPECT) to predict cardiac death in chronic hemodialysis patients using the iodinated fatty acid analogue iodine-123 123I-beta-methyl iodophenyl-pentadecanoic acid (BMIPP).BACKGROUNDWe previously reported that BMIPP SPECT could detect asymptomatic coronary artery disease with high sensitivity in hemodialysis patients.METHODSWe prospectively enrolled 375 asymptomatic hemodialysis patients who had undergone dual SPECT using 123I-BMIPP and 201thallium (Tl) chloride. Patients who had a clinical history of myocardial infarction and/or coronary revascularization were excluded from the study. Uptake on SPECT images was graded in 17 segments on a 5-point scale (0 normal, 4 absent) and assessed as summed BMIPP or Tl scores.RESULTSDuring a 3.6 +/- 1.0-year follow-up, 57 patients who had undergone coronary revascularization within 60 days of SPECT were excluded from the analysis. Among the remaining 318 patients (male/female: 170/148; 64 +/- 12 years of age), 50 died of cardiac events (acute myocardial infarction 22, congestive heart failure 17, cardiac sudden death 11). Stepwise Cox hazard analysis associated cardiac death with age (> or =70 years) and with severely abnormal BMIPP SPECT images (BMIPP summed scores > or =12: hazard ratio 21.894; p < 0.0001). Kaplan-Meier analysis showed that the cardiac death-free survival rates at 3 years were 61% and 98% in patients with BMIPP summed scores of > or =12 and <12, respectively.CONCLUSIONSSeverely impaired myocardial fatty acid metabolism, which might mainly reflect repetitive myocardial ischemia, can identify a high-risk group of cardiac death among hemodialysis patients. Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging Masato Nishimura, Kazumasa Tsukamoto, Naoyuki Hasebe, Nagara Tamaki, Kenjiro Kikuchi, Toshihiko Ono This prospective cohort study showed that the occurrence of cardiac death among patients on maintenance hemodialysis is closely associated with severely abnormal β-methyl iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography images. Kaplan-Meier survival estimates showed that survival rates worsened with an increasing summed BMIPP score. Highly impaired myocardial fatty acid metabolism can identify groups of hemodialysis patients at high risk for cardiac death. The aim was to evaluate the potential of single-photon emission computed tomography (SPECT) to predict cardiac death in chronic hemodialysis patients using the iodinated fatty acid analogue iodine-123 (123I)–β-methyl iodophenyl-pentadecanoic acid (BMIPP). We previously reported that BMIPP SPECT could detect asymptomatic coronary artery disease with high sensitivity in hemodialysis patients. We prospectively enrolled 375 asymptomatic hemodialysis patients who had undergone dual SPECT using 123I–BMIPP and 201thallium (Tl) chloride. Patients who had a clinical history of myocardial infarction and/or coronary revascularization were excluded from the study. Uptake on SPECT images was graded in 17 segments on a 5-point scale (0 normal, 4 absent) and assessed as summed BMIPP or Tl scores. During a 3.6 ± 1.0-year follow-up, 57 patients who had undergone coronary revascularization within 60 days of SPECT were excluded from the analysis. Among the remaining 318 patients (male/female: 170/148; 64 ± 12 years of age), 50 died of cardiac events (acute myocardial infarction 22, congestive heart failure 17, cardiac sudden death 11). Stepwise Cox hazard analysis associated cardiac death with age (≥70 years) and with severely abnormal BMIPP SPECT images (BMIPP summed scores ≥12: hazard ratio 21.894; p < 0.0001). Kaplan-Meier analysis showed that the cardiac death-free survival rates at 3 years were 61% and 98% in patients with BMIPP summed scores of ≥12 and <12, respectively. Severely impaired myocardial fatty acid metabolism, which might mainly reflect repetitive myocardial ischemia, can identify a high-risk group of cardiac death among hemodialysis patients. |
Author | Tsukamoto, Kazumasa, PhD Kikuchi, Kenjiro, MD, PhD Nishimura, Masato, MD, PhD Ono, Toshihiko, MD Hasebe, Naoyuki, MD, PhD Tamaki, Nagara, MD, PhD |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/18191738$$D View this record in MEDLINE/PubMed |
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Keywords | CHF CRP ESRD 123I C-reactive protein myocardial infarction LV SPECT thallium receiver-operating characteristic BMIPP Tl congestive heart failure left ventricular MI ROC percutaneous coronary artery intervention coronary artery bypass graft end-stage renal disease β-methyl iodophenyl-pentadecanoic acid adenosine triphosphate PCI CABG ATP 123iodine single-photon emission computed tomography |
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Snippet | Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging Masato Nishimura, Kazumasa Tsukamoto, Naoyuki Hasebe, Nagara Tamaki,... Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging Masato Nishimura, Kazumasa Tsukamoto, Naoyuki Hasebe, Nagara Tamaki,... The aim was to evaluate the potential of single-photon emission computed tomography (SPECT) to predict cardiac death in chronic hemodialysis patients using the... OBJECTIVESThe aim was to evaluate the potential of single-photon emission computed tomography (SPECT) to predict cardiac death in chronic hemodialysis patients... |
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SubjectTerms | Aged Aged, 80 and over Cardiology Cardiovascular Cardiovascular disease Cohort Studies Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - etiology Coronary Artery Disease - mortality Death Death, Sudden, Cardiac Fatty Acids Female Heart attacks Hemodialysis Humans Internal Medicine Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - therapy Male Medical imaging Middle Aged Multivariate Analysis Predictive Value of Tests Probability Proportional Hazards Models Prospective Studies Renal Dialysis - adverse effects Renal Dialysis - methods Risk Assessment ROC Curve Sensitivity and Specificity Thallium Radioisotopes Tomography, Emission-Computed, Single-Photon |
Title | Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging |
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