BACKGROUND & AIMS:
BACKGROUND:Detecting myocardial ischemia in hemodialysis patients is crucial given the high incidence of silent ischemia and the high cardiovascular mortality rates. Abnormal myocardial fatty acid metabolism as determined by imaging with (123)I-labeled BMIPP (β-methyl iodophenyl-pentadecanoic acid) might be associated with cardiac-derived death in hemodialysis patients.
STUDY DESIGN:Prospective observational study.
SETTING & PARTICIPANTS:Asymptomatic hemodialysis patients with one or more cardiovascular risk factors, but without known coronary artery disease, were followed up for 3 years at 48 Japanese hospitals (406 men, 271 women; mean age, 64 years).
PREDICTOR:Baseline BMIPP summed scores semiquantified using a 17-segment 5-point system (normal, 0; absent, 4).
OUTCOMES:Cardiac-derived death, including cardiac and sudden death.
MEASUREMENTS:HRs were estimated using a Cox model for associations between BMIPP summed scores and cardiac-derived death, adjusting for potential confounders of age, sex, body mass index, dialysis duration, and cardiovascular risk factors.
RESULTS:Rates of all-cause mortality and cardiac-derived death were 18.5% and 6.8%, respectively. Cardiac-derived death (acute myocardial infarction [n = 10], congestive heart failure [n = 13], arrhythmia [n = 2], valvular heart disease [n = 1], and sudden death [n = 20]) accounted for 36.8% of all-cause deaths. Cardiac-derived death (n = 46) was associated with age, history of heart failure, and BMIPP summed scores of 4 or higher (HR, 2.9; P < 0.001). Three-year cardiac-derived death-free survival rates were 95.7%, 90.6%, and 78.8% when BMIPP summed scores were 3 or lower, 4-8, and 9 or higher, respectively. BMIPP summed score also was a predictor of all-cause death (HR, 1.6; P = 0.009).
LIMITATIONS:Sudden death of unknown cause was considered to have been cardiac derived, although a coronary origin was not confirmed.
CONCLUSIONS:Abnormal myocardial fatty acid metabolism is associated with cardiac-derived death in hemodialysis patients. BMIPP single-proton emission computed tomography appears clinically useful for predicting cardiac-derived death in this population.
背景与目标:
背景:鉴于无声缺血的发生率高和心血管死亡率高,检测血液透析患者的心肌缺血至关重要。通过用(123)I标记的BMIPP(β-甲基碘苯基-十五烷酸)成像确定的心肌脂肪酸代谢异常,可能与血液透析患者的心源性死亡有关。
研究设计:前瞻性观察研究。
地点和参与者:无症状的血液透析患者,具有一种或多种心血管危险因素,但无已知的冠心病,在日本的48家医院接受了3年的随访(男性406例,女性271例;平均年龄64岁)。
预测:基线BMIPP汇总分数使用17段5分制(正常,0;不存在,4)进行半量化。
结果:心脏源性死亡,包括心源性和猝死。
测量:使用Cox模型估算BMIPP总得分与心脏源性死亡之间的关联,并校正年龄,性别,体重指数,透析时间和心血管危险因素等潜在混杂因素,从而对心率进行评估。
结果:全因死亡率和心源性死亡率分别为18.5%和6.8%。心源性死亡(急性心肌梗死[n = 10],充血性心力衰竭[n = 13],心律不齐[n = 2],瓣膜性心脏病[n = 1]和猝死[n = 20])全因死亡人数的36.8%。心脏源性死亡(n = 46)与年龄,心衰史和BMIPP总分4分或更高(HR,2.9; P <0.001)相关。当BMIPP总分分别为3或更低,4-8和9或更高时,三年的心脏衍生无死生存率分别为95.7%,90.6%和78.8%。 BMIPP总分也是全因死亡的预测指标(HR,1.6; P = 0.009)。
局限性:尽管未确认冠状动脉起源,但未知原因的猝死被认为是由心脏引起的。
结论:血液透析患者心肌脂肪酸代谢异常与心脏源性死亡有关。 BMIPP单质子发射计算机断层扫描在临床上可用于预测该人群的心脏源性死亡。