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J Am Coll Cardiol, 2008; 51:139-145, doi:10.1016/j.jacc.2007.08.057
© 2008 by the American College of Cardiology Foundation
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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{ddagger}, Naoyuki Hasebe, MD, PhD§, Nagara Tamaki, MD, PhD||, Kenjiro Kikuchi, MD, PhD§,1 and Toshihiko Ono, MD{dagger}

* Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan
{dagger} Division of Urology, Toujinkai Hospital, Kyoto, Japan
{ddagger} 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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