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

AIMS:

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.

METHODS AND 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: Tomoaki Nakata, Akiyoshi Hashimoto, Masao Moroi, Nagara Tamaki, Tsunehiko Nishimura, Naoyuki Hasebe, Kenjiro Kikuchi, Eiji Nakatani
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 17 Issue 12 Pg. 1394-1404 (Dec 2016) ISSN: 2047-2412 [Electronic] England
• PMID: 26710818 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: [email protected].

Chemical References

• Biomarkers
• Fatty Acids
• C-Reactive Protein

Topics

• Adult
• Age Factors
• Aged
• Analysis of Variance
• Biomarkers (blood)
• C-Reactive Protein (metabolism)
• Cohort Studies
• Death, Sudden, Cardiac (etiology, pathology)
• Electrocardiography (methods)
• Fatty Acids (blood)
• Female
• Humans
• Kaplan-Meier Estimate
• Kidney Failure, Chronic (diagnosis, mortality, therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (diagnostic imaging)
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• ROC Curve
• Renal Dialysis (adverse effects, methods)
• Risk Assessment
• Sex Factors
• Survival Analysis
• Tomography, Emission-Computed, Single-Photon (methods)