title: Cardiac event risk stratification in patients with end-stage renal disease: Sub-analysis of the B-SAFE study.
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.
authors.affiliation: Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan. Electronic address: k-zen@hera.eonet.ne.jp.
authors.forename: Kan
authors.initials: K
authors.lastname: Zen
authors.affiliation: Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.affiliation: Cardiovascular Division, Tojinkai Hospital, Kyoto, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Department of Statistical Analysis, Translational Research Informatics Center, Kobe, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nakatani
authors.affiliation: Department of Cardiology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Moroi
authors.affiliation: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Cardiovascular Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical College, Asahikawa, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
authors.affiliation: Cardiovascular Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical College, Asahikawa, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kikuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D005227:Fatty Acids / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007457:Iodine Radioisotopes; D007462:Iodobenzenes / Q000494:pharmacology*; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D055815:Young Adult
chemical_list: D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; C049338:iodofiltic acid
keywords: Cardiac event; Coronary heart disease; Diabetes mellitus; Maintenance haemodialysis; Metabolic imaging; Peripheral artery disease