Triglyceride deposit cardiomyovasculopathy as a predictor of vascular failure after coronary intervention in patients with hemodialysis: a preliminary analysis.

Patients on hemodialysis (HD) are at high risk of vascular failure after percutaneous coronary intervention (PCI), even with new-generation drug-eluting stents (DES). Triglyceride deposit cardiomyovasculopathy (TGCV), a recently recognized cardiac metabolic disorder, features defective intracellular triglyceride hydrolysis with diffuse, concentric coronary narrowing, which may attenuate DES efficacy through distinct vascular remodeling biology, but its clinical impact remains unclear. This is a subanalysis of a retrospective, single-center study evaluating the prevalence and clinical outcomes of TGCV among HD patients. We included HD and catheter database data between April 2011 and March 2017. Among 118 patients suspected coronary artery disease, 26 patients who underwent [123I]-β-methyl-iodophenyl-pentadecanoic acid scintigraphy and a 12-month follow-up coronary angiography after DES implantation were analyzed. Patients were divided into the TGCV or non-TGCV group. The primary endpoint was in-stent late loss. The secondary endpoints were binary in-stent restenosis (ISR) and target lesion revascularization (TLR). Nine patients (34.6%) had TGCV. In-stent late loss was higher in the TGCV group than in the non-TGCV group (median 1.17 mm versus 0.29 mm; p < 0.001), with significantly higher ISR and TLR (58.3% versus 9.5%; p = 0.005; adjusted odds ratio [OR] 18.1, 95% confidence interval [CI] 2.23-146 and 50.0% versus 9.5%; p = 0.015; adjusted OR 12.3, 95% CI 1.62-93.2, respectively). TGCV was associated with higher vascular failure after DES implantation in HD patients, and might represent a potential therapeutic target after PCI. Given the small cohort and wide CIs, these findings are preliminary and hypothesis-generating, warranting validation in larger, prospective studies.