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.
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Figure 1 Entry and Exclusion of Study Participants
BMIPP = β-methyl iodophenyl-pentadecanoic acid; CABG = coronary artery bypass graft; PCI = percutaneous coronary intervention; SPECT = single-photon emission computed tomography; Tl = thallium.
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Figure 2 Kaplan-Meier Analysis of Cardiac Death-Free Survival Rate by BMIPP SPECT
(A) Event-free survival rates of cardiac death at 3 years are 61% for patients with BMIPP summed scores of  12 and 98% for those with scores <12. Log rank test: p < 0.0001. (B) Event-free rates of cardiac death became aggravated with increasing summed BMIPP scores when separated into 5 subgroups according to BMIPP summed scores. Log rank test: p < 0.0001. Abbreviations as in Figure 1.
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Figure 3 BMIPP and Tl SPECT Images From Patients Who Died of Cardiac Events
(A) A 75-year-old woman, whose summed BMIPP and Tl scores were 37 and 7, respectively, died of acute myocardial infarction 11 months after SPECT. Coronary angiography within 60 days of BMIPP SPECT revealed significant stenoses in the left main trunk (75%) right coronary artery (#2 75%), left anterior descending artery (#6 75%, #9 90%), and left circumflex artery (#12 75%, #13 75%). The patient refused invasive therapy, thus negating the possibility of coronary intervention. (B) A 74-year-old man whose summed BMIPP and Tl scores were 36 and 6, respectively, died of congestive heart failure 31 months after SPECT. Coronary angiography did not find significant stenosis of >50% within 60 days of SPECT. (C) A 61-year-old man whose summed BMIPP and Tl scores were 18 and 0, respectively, died of sudden cardiac events 38 months after SPECT. Coronary angiography did not find significant stenosis within 60 days of SPECT. Abbreviations as in Figure 1.
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Figure 4 Kaplan-Meier Analysis of Cardiac Death-Free Survival Rate by BMIPP–Tl Mismatch
Event-free survival rates of cardiac death at 3 years are 53% for patients with mismatch scores of 7 and 96% for those with scores <7. Log rank test: p < 0.0001. Abbreviations as in Figures 1 and 3.
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