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CLINICAL RESEARCH: CARDIAC IMAGING

Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging

Masato Nishimura, MD, PhD^_*,_*, Kazumasa Tsukamoto, PhD, Naoyuki Hasebe, MD, PhD, Nagara Tamaki, MD, PhD^||, Kenjiro Kikuchi, MD, PhD^,1 and Toshihiko Ono, MD

^_* Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan
Division of Urology, Toujinkai Hospital, Kyoto, Japan
Department of Environment and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
First Department of Internal Medicine, Asahikawa Medical College, Asahikawa, Japan
^|| Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Manuscript received June 11, 2007; revised manuscript received August 9, 2007, accepted August 13, 2007.

^_* Reprint requests and correspondence: Dr. Masato Nishimura, Cardiovascular Division, Toujinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto 612-8026, Japan. (Email: mnishimura{at}tea.ocn.ne.jp).

Objectives: 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).

Background: We previously reported that BMIPP SPECT could detect asymptomatic coronary artery disease with high sensitivity in hemodialysis patients.

Methods: 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.

Results: 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.

Conclusions: 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.

Abbreviations and Acronyms   ATP = adenosine triphosphate   BMIPP = β-methyl iodophenyl-pentadecanoic acid   CABG = coronary artery bypass graft   CHF = congestive heart failure   CRP = C-reactive protein   ESRD = end-stage renal disease   123I = 123iodine   LV = left ventricular   MI = myocardial infarction   PCI = percutaneous coronary artery intervention   ROC = receiver-operating characteristic   SPECT = single-photon emission computed tomography   Tl = thallium

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