title: Sudden death prediction by C-reactive protein, electrocardiographic findings, and myocardial fatty acid uptake in haemodialysis patients: analysis of a multicentre prospective cohort sub-study.
abstract: OBJECTIVE
  The purpose of this study was to identify determinants of sudden death among clinical information in combination with cardiac fatty acid metabolism for better risk-stratification of haemodialysis patients.
  
  
  RESULTS
  Clinical and imaging data from 677 haemodialysis patients enrolled in the beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) SPECT Analysis for Decreasing Cardiac Events in Hemodialysis Patients (B-SAFE) study were analysed in this study. During a 3-year prospective follow-up interval, 20 sudden deaths were observed. Compared with non-sudden death patients, sudden death patients more frequently had an increased C-reactive protein level (>2.38 mg/dL), electrocardiographic abnormal Q-wave and increased BMIPP abnormality score (>16). Patients with BMIPP score >16 and at least one of the other predictors had significantly lower event-free rates than did those without the BMIPP abnormality (P < 0.001). Univariate and multivariate Cox regression analyses revealed increased C-reactive protein level, abnormal Q-wave, and greater BMIPP abnormality as significant sudden death predictors with hazards ratios of 6.83 (95% CI: 1.76-26.47, P = 0.005), 17.73 (95% CI: 4.91-63.98, P < 0.001), and 10.58 (95% CI; 3.84-29.14, P < 0.001), respectively. The addition of BMIPP score >16 to the other clinical predictors increased the hazard ratio and receiver-operating characteristic analysis-area under the curve up to 145.22 (95% CI; 0.34-695.09) and to 0.677-0.690, respectively.
  
  
  CONCLUSIONS
  Increased C-reactive protein, electrocardiographic Q-wave, and impaired myocardial fatty acid metabolism are independently and synergistically related to sudden death risk in haemodialysis patients. The non-invasive strategy presented here might contribute to the identification of haemodialysis patients who can most benefit from a prophylactic treatment against sudden death.
authors.affiliation: Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan tnakata@sapmed.ac.jp.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakata
authors.affiliation: Department of Cardiology, Nephrology, Metabolism and Endocrinology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hashimoto
authors.affiliation: Department of Cardiology, Ohashi-Medical Center, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Moroi
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: 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: Hokkaido Cardiovascular Hospital, Sapporo, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D004562:Electrocardiography / Q000379:methods; D005227:Fatty Acids / Q000097:blood*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D015415:Biomarkers; D005227:Fatty Acids; D002097:C-Reactive Protein
keywords: C-reactive protein; electrocardiographic Q-wave; haemodialysis; myocardial fatty acid metabolism; nuclear imaging; sudden death