title: Association between abnormal myocardial fatty acid metabolism and cardiac-derived death among patients undergoing hemodialysis: results from a cohort study in Japan.
abstract: 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.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  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).
  
  
  METHODS
  Baseline BMIPP summed scores semiquantified using a 17-segment 5-point system (normal, 0; absent, 4).
  
  
  RESULTS
  Cardiac-derived death, including cardiac and sudden death.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, National Center for Global Health & Medicine, Tokyo 162-8655, Japan. moroi@med.toho-u.ac.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Moroi
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Haze
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Nishimura
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.forename: Tokuichiro
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hase
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hara
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakata
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kumita
authors.forename: Yoji
authors.initials: Y
authors.lastname: Nagai
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Momose
authors.forename: Keiko
authors.initials: K
authors.lastname: Miyakoda
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kikuchi
mesh_terms: D015331:Cohort Studies; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D006331:Heart Diseases / Q000378:metabolism* / Q000401:mortality*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011446:Prospective Studies; D006435:Renal Dialysis
chemical_list: D005227:Fatty Acids