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Prevalence and clinical outcomes of triglyceride deposit cardiomyovasculopathy among haemodialysis patients
  1. Tomohiro Onishi1,
  2. Yusuke Nakano1,
  3. Ken-ichi Hirano2,
  4. Yasuyuki Nagasawa3,
  5. Toru Niwa4,
  6. Atomu Tajima4,
  7. Hideki Ishii5,
  8. Hiroshi Takahashi6,
  9. Shinichiro Sakurai1,
  10. Hirohiko Ando1,
  11. Hiroaki Takashima1,
  12. Tetsuya Amano1
  1. 1 Department of Cardiology, Aichi Medical University, Nagakute, Japan
  2. 2 Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics, Graduate School of Medicine, Osaka University, Suita, Japan
  3. 3 Department of Internal Medicine, Division of Cardiology, Kidney and Dialysis, Hyogo College of Medicine, Nishinomiya, Japan
  4. 4 Narita Memorial Hospital, Toyohashi, Japan
  5. 5 Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
  6. 6 Medical Statistics, Fujita Health University, Toyoake, Japan
  1. Correspondence to Professor Tetsuya Amano, Cardiology, Aichi Medical University, Nagakute 480-1195, Japan; amanot{at}aichi-med-u.ac.jp

Abstract

Objective To evaluate the effect of triglyceride deposit cardiomyovasculopathy (TGCV) on the cardiovascular outcomes in haemodialysis (HD) patients with suspected coronary artery disease (CAD).

Methods This retrospective single-centre observational study included data from the cardiac catheter database of Narita Memorial Hospital between April 2011 and March 2017. Among 654 consecutive patients on HD, the data for 83 patients with suspected CAD who underwent both [123I]-β-methyl-iodophenyl-pentadecanoic acid scintigraphy and coronary angiography were analysed. Patients were divided into three groups: definite TGCV (17 patients), probable TGCV (22 patients) and non-TGCV control group (44 patients). The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke assessed for up to 5 years of follow-up.

Results The prevalence of definite TGCV was approximately 20% and 2.6% among consecutive HD patients with suspected CAD and among all HD patients, respectively. At the end of the median follow-up period of 4.7 years, the primary endpoint was achieved in 52.9% of the definite TGCV patients (HR, 7.45; 95% CI: 2.28 to 24.3; p<0.001) and 27.3% of the probable TGCV patients (HR, 3.28; 95% CI: 0.93 to 11.6; p=0.066), compared with that in 9.1% of the non-TGCV control patients. Definite TGCV was significantly and independently associated with cardiovascular mortality and outcomes among HD patients in all multivariate models.

Conclusions TGCV is not uncommon in HD patients and is associated with an increased risk of cardiovascular events including cardiovascular death. Thus, TGCV might be a potential therapeutic target.

  • nuclear cardiac imaging
  • coronary artery disease
  • metabolic heart disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2020-317672

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    Footnotes

    • Contributors YN and TA conceived of the presented idea. YN and KH developed the theory and performed the computation. HA and HT devised the project. TN, AT and SS worked out almost all of the technical details. HI and HT verified the analytical methods. TO wrote the manuscript, with help from TA. All authors provided critical feedback and helped shape the research and manuscript. TA and KH are responsible for the overall content as guarantors.

    • Funding This work was supported by research grants from the Ministry of Health, Labour and Welfare and the Japan Agency of Medical Research and Development [A-MED; grant number 17ek0109092h0003] and Grant-in-Aid for Scientific Research [KAKENHI; grant number 19K11705].

    • Competing interests KH has a licensed patent (WO2013031729) and has received a research grant from Nihon Medi-Physics Co. YN receives lecture fees from Mitsubishi Tanabe Pharma Co., Eli Lilly Japan KK and Nippon Boehringer Ingelheim Co., Ltd. HI receives lecture fees from Astellas Pharma, AstraZeneca, Bayer Pharmaceutical Co., Ltd., Chugai Pharma Inc., Daiichi-Sankyo Co., Ltd. and MSD KK. TA receives lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi Sankyo and Bristol-Myers Squibb.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval This study was conducted following the guidelines of the Declaration of Helsinki. The Ethics Committee of the Narita Memorial Hospital (R1-23-02) approved the study, and written informed consent was obtained from all patients or their families.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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