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.

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.