心力衰竭的放射性核素顯像評價(jià)

心力衰竭的放射性核素顯像評價(jià)何作祥國家心血管病中心心血管病國家重點(diǎn)實(shí)驗(yàn)室中國醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院第三屆全國心血管疾病檢驗(yàn)及影像診斷學(xué)論壇,2012MyocardialPerfusionGatedSPECTWangF,etal.EurJNuclMedMolImaging,2009RegionalwallmotioninDCMbygated

SPECTandcardiacMRI(n=36)CineMRIGatedSPECTSeverehypokinesiaAkinesiaordyskinesiaTotalSeverehypokinesia5559564Akinesiaordyskinesia242448Total57933612WangF,etal.EurJNuclMedMolImaging2009;36:1611–1621Leftventricularfunction:MUGAleftlateralLAOanteriorPositron-labeledtraceranalogsforeitherfattyacidsorglucoseTaegtmeyerH,JNuclMed2010;51:80S–87SMyocardialViabilityClinical–anginaPET(goldstandard)MRIThalliumDobutamineEchoGuludecDL,EurJNuclMedMolImaging(2008)35:1709–172412MyocardialSPECTandPET/CTImagingDCBASestamibiFDGSestamibiFDGESestamibiFFDGMyocardialSPECTandPET/CTImagingFDGFDGFDGSestamibiSestamibiSestamibiMyocardialSPECTandPET/CTImagingQPSQGS

7778810131417232116141313101020SurvivalinPatientswithPET“Mismatch”04812162024283200.20.40.60.81.0

RevascularizationMedicalTherapyLowRank

2=4.60p=0.03MonthsofFollow-UpCumulativeSurvivalPETImagingPatternsandMortality

inPatientswithCADandLVDysfunctionViableNonviable#MedicalRevasc.MedicalRevasc.Eitzman836/181/262/240/14DiCarli937/173/263/331/17Lee13710/214/492/402/19Total31323/568/1017/973/50Mortality41%8%7%6%MyocardialViabilityandImpactofRevascularisationinPatientswithCADDiseaseandLVDysfunction:AMeta-Analysis-58.4%ViableNon-viableViableNon-viableREVASCULARISEDMEDICALTHERAPYp<0.0001p<0.001158%Numberofstudies=24N=3,088EF=32%±8%FU25±10MthsDeathRate(%/Yr)Abraham1A,JNuclMed2010;51:567–574AdjustedsurvivalcurvesforPETandstandardarmsinOttawa-FIVEsubstudyContrastMRIvs.FDGSPECTLiuQ,etal.NuclMedComm2009SPECTMRIPerfusionSPECTandFDGPETinDCMandHFSestamibiFDGSestamibiFDGSestamibiFDGQPSQGSMyocardialSPECTandPET/CTImagingGatedperfusionSPECTandFDGPETinHFandLBBBFDGFDGFDGSestamibiSestamibiSestamibiPerfusion/MetabolismmismatchinDCMNegliaD,PharmacologicReports2005;57(suppl):151-155Dipyridamole-inducedmismatchusing13N-NH3/18F-FDGPETinpatientswithIDCAltehoeferC.LBBB:challengingourconceptofmetabolicheartimagingwithfluorine-18-FDGandPET?JNuclMed1998;39:263–265.Kaplan-MeiersurvivalaccordingtothepresenceofMismatchinDCMJNuclCardiol2009;16:769–74BMIandrestmyocardialperfusiondefectpredictscardiacdeathinptswithchronicHFCaiM,etal.IntJCardiovasvImaging2012123I-MIBGANDCHFMetaiodobenzilguanidine(MIBG)isananalogueofthefalseneurotransmitterguanetidine,apotentneuronblockingagentthatactsselectivelyonsympatheticnerves.MIBGandnoradrenalinehaveasimilarmolecularstructureandsharethesameuptakeandstoragemechanismsinthesympatheticnerveendings.MIBGisnotmetabolizedbymonoamineoxidase;thus,localizationofMIBGrelatestothepresenceofsympatheticnervesandtotissuenoradrenalinecontent.MIBGiscurrentlylabelledwith123-Ifordiagnosticpurposesandwith131-Ifortherapy28/11/2006EF=13%EDV=350ml10/07/2007EF=60%EDV=110mlEurJNuclMedmolecularImaging,2009;36:2068AgostiniD.EurJNuclMedMolImaging(2008)35:535–546123-mIBGmyocardialimagingforassessmentofriskforamajorcardiaceventinHFPtsJacobsonAF,etal.JAmCollCardiol.2010May18;55(20):2212-212-YearCardiacDeathandAll-CauseMortalityRatesJacobsonAF,etal.JAmCollCardiol.2010May18;55(20):2212-21CumulativeEventCurvesinRelationtoBNP,LVEF,andH/MJacobsonAF,etal.JAmCollCardiol.2010May18;55(20):2212-21CumulativeEventCurvesinRelationtoBNP,LVEF,andH/MJacobsonAF,etal.JAmCollCardiol.2010May18;55(20):2212-21HSV-ttk報(bào)告基因干細(xì)胞PET成像18F-FHBG18F-FDGInfluenceofintracoronarystemcelltherapyonLVEF,infarctarea,andFDGmetabolisminPETstudyBeforeTxAfterTxDifferencePValueLVEF,%529607+15%0.0001Infarctarea,%278199-30%0.0001FDG-PET,%43.88.050.511.6+15%0.012ModifiedfromStraueretal.JACCVol.46,No.9,2005RegenerationofHumanInfarctedHeart

MusclebyIntracoronaryAutologousBoneMarrow

CellTransplantationinChronicCAD:TheIACTStudyStraueretal.JACCVol.46,No.9,20050102DilatedCardiomyopathyDuetoDoxorubicin/

AnthracyclineCardiotoxicityRNAisanidealnoninvasivetooltoprovidelongitudinalquantitativeassessmentofLVfunctioninpatientsreceivingdoxo