Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging

Nishimura, Masato; Tsukamoto, Kazumasa; Hasebe, Naoyuki; Tamaki, Nagara; Kikuchi, Kenjiro; Ono, Toshihiko

doi:10.1016/j.jacc.2007.08.057

Cited by 73 publications

(69 citation statements)

References 23 publications

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“…Among patients with a summed 123 I-BMIPP score of $12 event-free survival at 3 y was 61%, whereas for those with a summed 123 I-BMIPP score of ,12 event-free survival was 98%. When 123 I-BMIPP uptake (metabolism) was assessed in relation to regional thallium uptake (perfusion), indicating myocardial ischemia, the sensitivity and specificity of metabolism:perfusion mismatch for predicting cardiac death were 86% and 88%, respectively (52). These findings support the assertion that altered cardiac metabolism (indicating silent myocardial ischemia) is highly prevalent in ESRD patients and can identify the subgroup of patients who are at high-risk for cardiac death (53).…”

Section: Screening Asymptomatic Patientssupporting

confidence: 61%

“…In a prospective study of 130 asymptomatic ESRD patients undergoing hemodialysis, significant coronary artery luminal narrowing ($75%) was present in 71% of ESRD patients (51). The same investigators subsequently examined the prognostic significance of reduced myocardial metabolism with 123 I-BMIPP in conjunction with perfusion abnormalities assessed with thallium in ESRD patients without prior myocardial infarction (52). Among the 318 asymptomatic hemodialysis patients who were prospectively enrolled in the study, 50 (16%) died of cardiac events during a mean follow-up period of 3.6 6 1.0 y.…”

Section: Screening Asymptomatic Patientsmentioning

confidence: 99%

“…Without these refined adaptive changes in metabolism, the resultant energy deficit could lead to cell death, either by apoptosis or necrosis. Thus, targeting intracellular metabolic processes for imaging will undoubtedly expand our ability to diagnose and treat subclinical or progressive cardiovascular disorders (45,52,53).…”

Section: Molecular Targets For Imaging Myocardiummentioning

confidence: 99%

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Nuclear Cardiac Stress Testing in the Era of Molecular Medicine

Vesely¹,

Dilsizian²

2008

J Nucl Med

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The objective of cardiac stress testing is to detect coronary artery disease (CAD) and to prevent future adverse events, such as myocardial infarction or death. The progression from electrocardiographically based stress testing to current SPECT and PET technologies has brought improvements in diagnostic efficacy and resolution. Myocardial perfusion imaging facilitates management of CAD in elective and acute settings by providing valuable diagnostic and prognostic information. Hybrid PET/CT and SPECT/CT systems impart complementary information of coronary anatomy and its physiologic significance on blood flow reserve. In the current era, diagnosis and treatment of cardiovascular disease is increasingly defined by underlying molecular and genomic aberrations rather than by clinical signs and symptoms alone. Nuclear imaging is uniquely primed to exploit the targeting of expressed cell-surface molecules and intracellular processes of cardiovascular disease and to foster the development of innovative therapeutic interventions in the future.

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Section: Screening Asymptomatic Patientssupporting

confidence: 61%

Section: Screening Asymptomatic Patientsmentioning

confidence: 99%

Section: Molecular Targets For Imaging Myocardiummentioning

confidence: 99%

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Nuclear Cardiac Stress Testing in the Era of Molecular Medicine

Vesely¹,

Dilsizian²

2008

J Nucl Med

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“…Nishimura et al reported that BMIPP summed defect scores (BMDS) could stratify a poor prognosis for cardiac or sudden death based on a cutoff value of 12 among patients on HD, including 33% of those with diabetic nephropathy; the cardiac death rates of patients with a lower BMDS over 5 years was quite low. 20 Another study at the same institute revealed that lower BMIPP uptake and insulin resistance may be associated with cardiac death among HD patients, even without obstructive coronary artery disease. 21 The present findings contradict these results, perhaps because the characteristics of the patients differed; that is, the prevalence of cardiac events and mortality is generally higher in patients on HD.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of <sup>123</sup>I-Betamethyl-p-Iodophenyl-Pentadecanoic Acid Single-Photon Emission Computed Tomography in Diabetic Patients With Suspected Ischemic Heart Disease

Momose

Miyake

Fukui

et al. 2012

Circ J

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Background: Because of their high risk for cardiovascular events, we investigated the role of 123 I-betamethyl-piodophenyl-pentadecanoic acid (BMIPP) SPECT in evaluating the prognosis of diabetic patients with suspected coronary heart disease. Methods and Results:We retrospectively registered 186 diabetic patients with suspected coronary heart disease, but no previous diagnosis of heart disease, who had been examined by BMIPP and thallium (TL) dual SPECT. They were followed for over 2 years. The dual SPECT images were scored to obtain summed defect scores for each SPECT image (BMDS, TLDS and mismatch score [MS]). The primary endpoint was the first incidence of all-cause cardiac events. The secondary endpoint was cardiac death. Clinical classical risk factors in addition to the stage of chronic kidney disease (CKD), as well as cardiac function, were included in the prognostic analysis. Cardiac events occurred in 39 patients, including 8 cardiac deaths. Kaplan-Meier analysis revealed significantly more frequent cardiac event rates in patients with than without MS ≥5 or BMDS ≥6 (P<0.0001). Cox hazard multivariate analysis showed that MS and CKD stage or BMIPP and CKD stage were independent predictors. Only hemodialysis was a significant prognostic indicator for cardiac death.Conclusions: BMIPP SPECT when combined with CKD stage accurately predicts cardiac events among diabetic patients with suspected ischemic heart disease. (Circ J 2012; 76: 2633 - 2639

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“…3, 4 Recently, a multicenter prospective cohort study in Japan, the B-SAFE (BMIPP single-photon emission computed tomography [SPECT] Analysis for Decreasing Cardiac Events he prevalence and incidence of end-stage kidney disease (ESKD) have continued to increase worldwide, and Japan is known to have the highest prevalence of ESKD in the world. In 2009, there were 67,000 predialysis chronic kidney disease stage G5 patients, 37,365 patients introduced to dialysis therapy, and 101 patients who received pre-emptive renal transplantation.…”

Section: Article P 153mentioning

confidence: 99%