Focal impairment in myocardial fatty acid imaging in the left anterior descending artery area, a strong predictor for cardiac death in hemodialysis patients without obstructive coronary artery disease

• Published in: European journal of nuclear medicine and molecular imaging Vol. 42; no. 10; pp. 1612 - 1621
• Main Authors: Nishimura, Masato, Hashimoto, Tetsuya, Tamaki, Nagara, Kobayashi, Hiroyuki, Ono, Toshihiko
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2015; Springer Nature B.V
• Subjects: Aged; Cardiology; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - metabolism; Coronary Stenosis - mortality; Coronary Vessels - diagnostic imaging; Coronary Vessels - metabolism; Death, Sudden, Cardiac - epidemiology; Fatty acids; Fatty Acids - metabolism; Fatty Acids - pharmacokinetics; Female; Heart attacks; Hemodialysis; Humans; Imaging; Incidence; Iodobenzenes - pharmacokinetics; Japan - epidemiology; Male; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Molecular Imaging - statistics & numerical data; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Prognosis; Radiology; Renal Dialysis - mortality; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Survival Rate; Tomography; Tomography, Emission-Computed, Single-Photon - statistics & numerical data; Myocardial infarction; Microcirculation; Scintigraphy; Fatty acid imaging; Sudden death
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-015-3120-8

Purpose We investigated whether impaired patterns of myocardial fatty acid imaging were associated with cardiac death in dialysis patients without coronary lesions. Methods We prospectively enrolled 155 hemodialysis patients without obstructive coronary artery disease, who had been examined by single-photon emission computed tomography (SPECT) using the iodinated fatty acid analogue BMIPP. Uptake of BMIPP on SPECT was graded in 17 segments on a five-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores. Of the enrolled 155 participants, we analyzed 95 who had BMIPP summed scores ≥ 6 (52 men and 43 women, 65 ± 11 years). BMIPP scores ≥ 2 in ≥ 2 consecutive segments in SPECT were defined as focal, and the others as non-focal pattern. Results Of 95 participants analyzed, 42 (44.2 %) showed focal and 53 (55.8 %) non-focal type. During follow-up for 5.1 ± 2.0 years, 42 died of cardiac events. The occurrence of cardiac death was higher in the focal than in the non-focal group (30/42 [71.4 %] versus 12/53 [22.6 %], p  = 0.001). In stepwise Cox hazard analysis, focal pattern was associated with cardiac death (hazard ratio 2.266), independent of impairment of BMIPP SPECT (BMIPP summed scores ≥ 12). The predictive potential of BMIPP SPECT for cardiac death was higher ( p  < 0.001) in the left anterior descending artery area compared with other coronary territories. Conclusions Focal impairment in myocardial fatty acid imaging in the left anterior descending area may strongly predict cardiac death in this population.