Zen K, Tamaki N, Nishimura M, Nakatani E, Moroi M, Nishimura T, Hasebe N, Kikuchi K. Cardiac event risk stratification in patients with end-stage renal disease: Sub-analysis of the B-SAFE study.
Int J Cardiol 2015;
202:694-700. [PMID:
26454538 DOI:
10.1016/j.ijcard.2015.09.119]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/26/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND
The aim of this study was to investigate whether 123I-labelled β-methyl iodophenyl-pentadecanoic acid (BMIPP) imaging as an abnormal myocardial fatty acid metabolism indicator better predicted fatal and non-fatal cardiac events than conventional predictors [e.g. peripheral artery disease (PAD) and diabetes mellitus (DM)] in haemodialysis patients.
METHODS
In a sub-analysis of the BMIPP SPECT Analysis for Decreasing Cardiac Events in Haemodialysis Patients (B-SAFE) study, 677 asymptomatic patients with ≥1 cardiovascular risk factor and without known coronary artery disease were followed for 3 years. The amount of radioactivity in each 17-left ventricular segment was graded visually and assigned a score from 0 (normal) to 4 (absent). Its total values were designated as baseline summed BMIPP scores. Outcome measures were composite cardiac events.
RESULTS
Cardiac events correlated with age, PAD [hazard ratio (HR): 2.15; p=0.003], DM (HR: 1.76; p=0.006) and summed BMIPP scores (4-8, HR: 1.82; p<0.001; ≥9, HR: 3.49; p<0.001). Cardiac event-free rates decreased with increasing summed BMIPP scores, PAD and DM. Areas under the receiver operating curves (AUCs) indicated that a BMIPP-based model (AUC: 0.656) was more predictive than DM or PAD models (AUC: 0.591); a model with all three was most predictive (AUC: 0.708). The three-year cardiac event-free rates significantly decreased in patients with PAD and/or DM in all summed BMIPP score categories.
CONCLUSIONS
Abnormal myocardial fatty acid metabolism strongly predicts cardiac events in haemodialysis patients; those with PAD or DM are at high risk for cardiac events.
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