冠心病存活心肌的评价技术和临床意义_李卫华.ppt

冠心病存活心肌的评价技术和临床意义 福建医科大学附属厦门第一医院 厦门市心血管病研究所 李卫华 三种存活心肌的基本特点鉴别 Factors Affecting LV Function after Coronary Revascularization The presence and extent of preoperative hibernation or stunning The presence of suitable coroanry anatomy Completeness of coronary revascularization Lack of perioperative necrosis Patency of the grafts Use of a reliable methods to detect improvement LV size Associated (unrelated) primary cardiomyopathy Myocardial Viability and Impact of Revascularization in Patients with CAD Disease and LV Dysfunction: A Meta-Analysis  Myocardial Viability Assessment with PET and PET/CT  Myocardial Perfusion/Metabolic 18F-FDG PET Myocardial Viability Assessment with PET and PET/CT  Myocardial Perfusion/Metabolic 18F-FDG PET Survival in Patients with PET “Mismatch” PET Imaging Patterns and Mortalityin Patients with CAD and LV Dysfunction  Myocardial Viability Assessment with PET and PET/CT  Myocardial Perfusion/Metabolic 18F-FDG PET Myocardial Viability Assessment with SPECT  201Tl SPECT Direct Detection of Viable Myocardium with 18F-FDG/ 99mTc-MIBI SPECT Direct Detection of Viable Myocardium with 18F-FDG/ 99mTc-MIBI SPECT Myocardial Viability Assessment with SPECT  Nitroglycerin intervenal SPECT Myocardial Viability Assessment with SPECT Myocardial Perfusion SPECT：Nitroglycerin Intervention Myocardial Viability Assessment with SPECT  Nitroglycerin 99mTc-MIBI SPECT Among the segments with uptake rate 30-70% in rest imaging, 42.3% of them increased to normal uptake(70%). Among the segments with uptake rate 30% in rest imaging, 50% of them increased to uptake30%. Nitrate-Augmented Myocardial Imaging Exercise Reinjection Exercise Nitrate+RI He ZX, et al. J Nucl Med 1993； He ZX, et al. Circulation 1997 Courtesy of Dr. Schelbert ? ? ? ? ? ? ? ? 7 7 7 8 8 10 13 14 17 23 21 16 14 13 13 10 10 20 From Di Carli et al. Am J Cardiol 1994;73:527. 0 4 8 1