Involvement of FFA Metabolism and Insulin Resistance in Cardiac Death
Condition: Kidney Disease; Coronary Artery Disease; Hemodialysis
MeSH terms: Kidney Diseases; Coronary Artery Disease; Insulin Resistance; Death
Study type: Observational

Summary: 
      The investigators evaluated predictive values of myocardial fatty acid metabolism and insulin
      resistance for cardiac death of hemodialysis patients with normal coronary arteries.
    

Detailed description: 
      Dialysis patients have extraordinarily high mortality rates. Cardiac diseases play an
      important role in deaths among end-stage renal disease (ESRD) patients undergoing renal
      replacement therapy. Previous studies have shown that maintenance hemodialysis patients have
      high prevalence of obstructive coronary artery disease. While obstructive coronary artery
      disease is undoubtedly involved in cardiac deaths induced by acute myocardial infarction or
      congestive heart failure and in sudden cardiac death, cardiac death can occur in hemodialysis
      patients who have apparently no pre-existing obstructive coronary artery disease. However,
      few studies have investigated the factors which are useful for stratifying the risk of
      cardiac death in dialysis patients with normal coronary arteries.

      We recently showed that visualizing severely impaired myocardial fatty acid metabolism on
      images can help not only to detect obstructive coronary artery disease [8], but also to
      identify patients at high risk of cardiac death among hemodialysis patients without coronary
      intervention or old myocardial infarction and among those with coronary revascularization by
      percutaneous coronary artery intervention. In addition, combination of impaired cardiac fatty
      acid metabolism with insulin resistance, which is one of the risk factors related with
      coronary atherosclerosis, may contribute to left ventricular dysfunction in patients with
      maintenance hemodialysis with normal coronary arteries. Impaired myocardial fatty acid
      metabolism and insulin resistance, both of which reduce the synthesis of myocardial adenosine
      triphosphate (ATP), are likely to be involved in fatal cardiac events by causing deficiency
      of myocardial energy supply. In this study, we prospectively investigated the potential of
      myocardial fatty acid metabolism and insulin resistance to predict cardiac death in
      hemodialysis patients without pre-existing obstructive coronary artery disease.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Hemodialysis patients who had normal coronary arteries identified by coronary angiography
        and underwent the examination of BMIPP SPECT and measurement of HOMA-IR as a parameter of
        insulin resistance.
      
Keywords: fatty acid metabolism; insulin resistance; cardiac death; hemodialysis; normal coronary arteries; Predictive values of impaired myocardial fatty acid metabolism or insulin resistance for cardiac death of hemodialysis patients with normal coronary arteries