运动负荷核素心肌灌注显像对冠心病的诊断价值

目的探讨运动负荷核素心肌灌注显像对冠心病的诊断价值。方法对117例疑有冠心病者,以冠状动脉造影（CAG）结果作为诊断标准,进行心电图平板活动试验和运动负荷核素心肌灌注断层显像两种检查,并将结果行对比分析。结果与CAG结果比较,心电图平板活动试验诊断冠心病的敏感性为60%,特异性为73%;运动负荷核素心肌灌注显像诊断冠心病的敏感性为87%,特异性为69%。结论运动负荷核素心肌灌注显像与心电图平板活动试验比较,敏感性高,特异性相近,对冠心病的无创性诊断具有重要价值。     

~(99m)Tc-MIBI心肌断层显像在心脏疾病诊治中的临床价值

随着医学科学的不断发展,心血管疾病的诊断手段日趋完善,但每一种检查方法都有一定的局限性。核素心肌显像是近年来新兴的非创伤性重要的检查手段。~(99m)Tc-MIBI心肌断层显像在冠心病的诊断及冠心病的治疗疗效判断具有特殊的临床价值,对冠心病诊断特异性及准确性较高,对其它心肌病变的心脏性疾病的诊断也有一定的临床价值,现将~(99m)Tc-MIBI心肌断层显像在心脏疾病诊治中的临床应用综述如下。     

核素心肌灌注显像对冠心病诊断及治疗效果的评价

为评价核素心肌灌注显像对冠心病诊断的价值,并用其判断血运重建术的疗效,对 ７２ 例冠心病或可疑冠心病患者行冠脉造影术与核素心肌灌注显像,并对其中１５ 例患者在血运重建术后复查心肌灌注显像。结果表明核素心肌显像诊断冠心病的灵敏度与特异性分别为９５％ 与 ８６％ ;血运重建术后平均缺血节段数无明显改变,平均缺血分数显著降低。结论:①核素心肌显像对冠心病诊断的灵敏度与特异性均很高;②血运重建术后,原缺血心肌供血明显改善。     

核素心肌灌注显像对冠心病诊断及治疗效果的评价

为评价核素心肌灌注显像对冠心病诊断的价值,并用其判断血运重建术的疗效,对７２例冠心病或可疑冠心病患者行冠脉造影术与核素心肌灌注显像,并对其中１５例患者在血运重建术后复查心肌灌注显像。结果表明核素心肌显像诊断冠心病的灵敏度与特异性分别为９５％与８６％;血运重建术后平均缺血节段数无明显改变,平均缺血分数显著降低。     

对比分析负荷核素心肌灌注断层显像与冠状动脉造影结果在冠心病诊断中的作用

目的对比分析负荷核素心肌灌注断层显像与冠状动脉造影结果在冠心病诊断中的作用。方法选取52例因胸闷、胸痛而疑似冠心病住院患者,同期行负荷核素心肌灌注断层显像和冠状动脉造影检查。结果冠状动脉造影和核素心肌灌注断层显像均为异常者31例,冠状动脉造影和核素心肌灌注断层显像均为正常者7例,冠状动脉造影正常而核素心肌灌注断层显像异常者12例,冠状动脉造影异常而核素心肌灌注断层显像正常者2例。结论核素心肌灌注断层显像与冠状动脉造影均为诊断冠心病的有效手段,但核素心肌灌注断层显像弥补了冠状动脉造影的不足,有必要鉴别核素心肌灌注断层显像阳性的非冠心病患者。     

腺苷负荷试验心肌灌注显像对冠心病的诊断价值

目的:分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点,评价其诊断冠心病的临床价值.方法:对68例临床疑诊冠心病患者,将其腺苷负荷试验心肌灌注显像结果与冠状动脉造影(CAG)结果进行对比分析.结果:在68例患者中,36例CAG阳性,其中腺苷心肌灌注显像检出病变33例(91.7%),未检出病变3例(8.3%);32例CAG阴性,其中腺苷心肌灌注显像异常3例(9.4%),正常29例(90.6%);腺苷心肌灌注显像对冠心病诊断的敏感性92.3%,特异性90.6%.结论:腺苷核素心肌灌注显像诊断冠心病敏感性及特异性均较高,是协助诊断冠心病的有效的无创性检查方法.     

核素心肌灌注显像在冠心病中的应用进展

多年来核素心肌灌注显像一直是全世界,尤其是美国最常用的冠心病诊断处理技术。现回顾并评价核素心肌灌注显像在冠心病诊断、危险度分层和预后评估,以及临床治疗决策中的价值。同时,联合冠状动脉钙化积分、螺旋CT冠状动脉造影及正电子发射体层摄影等其它无创检查将有助于冠心病的早期诊断、治疗决策和血运重建术的合理选择,减少冠心病患者总体医疗费用。     

腺苷负荷心肌灌注显像在冠心病诊断中的应用

目的:评价腺苷负荷心肌灌注显像试验对冠心病的诊断价值。方法:60例住院患者均行腺苷负荷心肌灌注显像和冠状动脉造影(CAG),腺苷以0.14mg/(kg.min)的速度外周静脉输入,第3分钟时,静脉注射放射性核素99mTc-MIBI740MBq,1.5h后进行心肌断层显像,若异常,次日行静息心肌显像,分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点。结果:CAG阳性42例中,心肌核素显像阳性37例(敏感性88%)。18例CAG无明显狭窄,其中13例心肌核素显像阴性(特异性为72%)。前降支病变36例,心肌核素前壁区域低灌注20例,回旋支病变22例,侧壁区域低灌注14例,右冠脉病变28例,下壁区域低灌注27例,右冠脉病变较前降支或回旋支病变的心肌核素显像阳性率高(P0.05)。在应用过程中,腺苷未出现明显不良反应。结论:腺苷负荷试验心肌核素灌注显像对于冠心病诊断的敏感性、特异性较高,对诊断冠心病具有重要意义。     

运动试验99mTc-MIBI心肌灌注断层显像诊断冠心病的临床评价

目的评价运动试验99mTc-MIBI心肌灌注断层显像对冠心病的诊断价值。方法对160例病人同时进行冠状动脉造影及运动试验99mTc-MIBI心肌断层显像。结果运动试验99mTc-MIBI心肌断层显像诊断冠心病的敏感性为91.1%,特异性为87.5%。对冠状动脉单支、双支、三支病变组病人诊断的敏感性分别为83.3%、93.8%和100.0%。结论运动试验99mTc-MIBI心肌断层显像对判断心肌缺血有较高的临床应用价值。     

腺苷负荷试验核素心肌显像在冠心病诊断中的应用

腺苷扩张冠状动脉所致的“盗血”使正常心肌与缺血心肌之间血流分布出现差异是腺苷核素心肌显像诊断冠心病的基础。大量研究证实，腺苷２０１Ｔｌ（２０１铊）心肌显像对冠心病的诊断价值与运动试验，潘生丁及多巴酚丁胺试验核素心肌显像相类似。特别适用于不能耐受运动试验的患者，与潘生丁相比，腺苷作用直接、迅速，扩冠效果好，副作用短暂，病人易耐受。常采用０．１４ｍｇ·ｋｇ／ｍｉｎ的速度静脉输入，共６分钟，第３分钟结束时注入核素行心肌显像。目前，在国外腺苷２０１Ｔｌ心肌显像已成为诊断冠心病及评价其预后的重要无创检查手段。腺苷９９ｍＴｃ－ＭＩＢＩ（９９ｍ锝－ＭＩＢＩ）心肌显像诊断冠心病国内外均未见报道，此工作有待于开展。     

药物负荷核素心肌灌注显影对冠心病的诊断价值

目的探讨药物负荷核素心肌灌注显像（MPI）对冠心病的诊断价值。方法回顾性分析88例疑有冠心病且同时行冠状动脉造影（CAG）和双嘧达莫或腺苷药物负荷核素MPI患者,CAG与MPI检查日期相差不超过14 d,以CAG检查结果作为诊断冠心病的金标准,对比分析药物负荷核素MPI敏感度、特异性等指标。结果药物负荷核素MPI诊断冠心病的敏感度、特异性、准确率分别为91.4%、73.3%、85.2%;在5例假阴性患者中,4例为单支病变,1例为双支病变,侧支循环均良好;8例假阳性患者中,3例为X综合征,4例为冠状动脉血流缓慢。结论药物负荷核素心肌灌注显像是无创诊断冠心病及心肌缺血的有效途径,其假阳性和假阴性患者多有相应的冠状动脉或心肌的病理生理基础。     

Myocardial perfusion scintigraphy in asymptomatic diabetic patients: a critical review

The increasing prevalence of diabetes mellitus and the associated high cardiovascular risk has made the non‐invasive identification of silent coronary heart disease in diabetic individuals an important issue. This strategy could identify higher risk asymptomatic patients with diabetes mellitus in whom coronary revascularization may improve the outcome beyond that achieved by currently recommended medical management. Stress myocardial perfusion imaging has been shown to be effective in detecting coronary heart disease and predicting adverse cardiac events in asymptomatic diabetic patients. However, the clinical utility of myocardial perfusion scintigraphy is debated intensively due to the paucity of prospective and outcome based evidence. The controversy stems from several observational studies, epidemiologic data and cost‐effectiveness analyses. Thus, although several authors and professional organizations advocate the use of stress imaging for screening higher risk asymptomatic diabetic patients, others are cautious in recommending any kind of stress testing in that population. This review is based on a broad survey of the literature and discusses the potential role of stress myocardial perfusion scintigraphy in screening asymptomatic diabetic subjects for coronary heart disease in the current era and in relation with other non‐invasive screening tools. Copyright © 2010 John Wiley & Sons, Ltd.     

冠状动脉CT血管成像对冠心病等危症患者诊断心肌缺血的价值

目的 评价冠状动脉CT血管成像（CCTA）对冠心病等危症患者诊断心肌缺血的价值。方法 回顾性收集100例均接受了CCTA与负荷核素心肌灌注显像（MPI）的冠心病等危症患者。采用目测直径法对CCTA图像狭窄程度进行判定,冠状动脉狭窄分为<50%,50%~69%和≥70%。相应MPI图像上心肌节段的核素分布分为:灌注正常及灌注异常。结果 400条冠状动脉中,22条冠状动脉狭窄程度≥50%,其中10条（45%）相应的心肌供血区域在MPI图像上出现心肌灌注异常;378条冠脉血管狭窄程度<50%及正常,其中18条（4.8%）冠状动脉的心肌供血区域在MPI图像上出现心肌灌注异常。CCTA对评估心肌缺血诊断的灵敏度、特异度、阳性预测值和阴性预测值分别为36%、97%、45%和95%。结论 CCTA用于诊断冠心病等危症患者心肌缺血时,确定诊断性能较低,排除诊断性能较好。     

Fatty Acid Imaging of the Heart

Imaging metabolic processes in the human heart yields valuable insights into the mechanisms contributing to myocardial pathology and allows assessment of the efficacy of therapies designed to treat cardiac disease. Recent advances in fatty acid (FA) imaging using positron emission tomography (PET) include the development of a method to assess endogenous triglyceride metabolism and the design of new fluorine-18 labeled tracers. Studies of patients with diabetes have shown that the heart is resistant to insulin-mediated glucose uptake and that metabolism of nonesterified FA is upregulated. Cardiac PET imaging has also recently shown the increase in myocardial FA uptake seen in obese patients can be reversed with weight loss. And a pilot study of patients with chronic kidney disease demonstrated that PET imaging can reveal myocardial metabolic alterations that parallel the decline in estimated glomerular filtration rate. Recent advances in FA imaging using single photon emission computed tomography (SPECT) have been accomplished with the tracer β-methyl-p-[¹²³I]-iodophenyl-pentadecanoic acid (BMIPP). Two meta-analyses showed this imaging technique has a diagnostic accuracy for the detection of obstructive coronary artery disease that compares favorably with SPECT myocardial perfusion imaging and that BMIPP imaging yields excellent prognostic data in patients across the spectrum of coronary artery disease. A recent multicenter study of patients presenting with acute coronary syndromes found BMIPP SPECT imaging has greater diagnostic sensitivity than, and enhances the negative predictive value of, clinical assessment alone. Because of their exquisite sensitivity, nuclear imaging techniques facilitate the study of physiologic processes that are the key to our understanding of cardiac metabolism in health and disease.     

Acquired Coronary Artery Disease in Patients with Congenital Heart Disease: Issues in Diagnosis and Management

Objective: Acquired coronary artery disease, initially thought to rarely affect survivors of congenital heart disease, is increasingly recognized in this population, as these patients grow in age and numbers in the recent era. This study reports our experience with coronary artery disease in adults with congenital heart disease and discusses treatment issues and the existing literature. Methods: Retrospective review of all charts of adults with congenital heart disease and acquired coronary artery disease was performed. Patients’ clinical characteristics, diagnosis, risk factors, noninvasive and invasive imaging and management data were recorded. Results: Coronary artery disease was diagnosed at 35–70 of age in 17 patients out of a total of 1345 adult congenital heart disease patients followed. Congenital heart disease was moderate or complex in 5 patients (4 repaired Tetralogy of Fallot, 1 repaired ventricular septal defect) and simple unrepaired atrial septal defect diagnosed later in life before or after coronary artery disease identi- fication in 12 patients. Coronary artery disease symptoms were present in 12 patients (8 myocardial infarctions, 4 exercise intolerance), while all patients had 2–3 risk factors for coronary artery disease. Coronary angiography showed 1–3 vessel disease treated with percutaneous coronary intervention in 7 patients, coronary artery bypass graft in 2 patients and both in 2 patients. Patients received appropriate medical therapy and remained stable for 1–17 years, while 2 patients are awaiting surgical pulmonary valve replacement in the near future. Conclusion: Coronary artery disease can develop in adults with congenital heart disease later in life in the presence of traditional risk factors, and prevention, screening and treatment strategies should be applied in this population. Further studies are needed to fully elucidate the extent of this issue in this increasing and ageing population and to determine its optimal medical, interventional and surgical management.     

99mTc－MIBI心肌灌注平面显像潘生丁试验在冠心病诊断中的价值

为了进一步证实９９ｍＴｃ－ＭＩＢＩ心肌灌注显像潘生丁试验对冠心病诊断的价值，我们采用国产ｒ照相机及计算机系统对４２例有胸痛症状的住院病人进行了９９ｍＴｃ－ＭＩＢＩ心肌灌注平面显像潘生丁试验和冠状动脉造影检查的对比研究。以冠状动脉造影结果分组，４２例受试者中２７例冠脉管腔有≥５０％的狭窄，男性２５例，女性２例，平均年龄５３．７０±８．５７岁。另外１５例冠脉造影正常，男性８例，女性７例，平均年龄５２．７３±１０．１０岁，作为正常对照组。潘生丁负荷为：０．７ｍｇ／ｋｇ×４ｍｉｎｉｖ，ＧＺＡ－１型ｒ照相机及计算机对心肌灌注显像图进行采集，平滑及灰阶开窗处理，由两名有经验的医师读片。结果表明：９９ｍＴｃ－ＭＩＢＩ心肌灌注平面显像对冠心病诊断的灵敏度为９６．３０％（２６／２７）；特异性为８０．００％（１２／１５）；对识别冠脉单支、双支、三支病变的灵敏度分别为１００％（１６／ｌ６）、８０．００％（４／５）和１００％（６／６）；全组共有４４支血管出现有意义的狭窄（≥５０％），心肌显像图上有３３支血管相应供血区出现放射性稀疏缺损，即检出病变血管的灵敏度为７５．００％（３３／４４）。对ＬＡＤ、ＬＣＸ、ＲＣＡ病变的检出率分别为９?     

CCTA联合DCG在冠心病心肌缺血诊断中的应用价值

目的探讨冠状动脉CT血管成像(CCTA)联合动态心电图(DCG)在冠心病心肌缺血诊断中的应用价值。 方法选取286例疑似冠心病心肌缺血患者,所有患者均在入院2周内行核素心肌灌注显像(MPI)、CCTA、DCG检查。统计MPI、CCTA、DCG检查结果,并以MPI检查作为金标准,对比CCTA、DCG单一与联合诊断结果。 结果286例患者中,MPI共诊断出176例心肌缺血,CCTA检查共发现183例心肌缺血,DCG检查共发现152例心肌缺血。CCTA＋DCG联合诊断特异度与CCTA、DCG对比,差异无统计学意义(P>0.05);CCTA＋DCG联合诊断敏感度、准确度高于CCTA及DCG(P<0.05)。 结论CCTA与DCG联合诊断冠心病心肌缺血敏感度和准确度较高,具有较高临床应用价值。     

Stable ischemic heart disease in the older adults

Ischemic heart disease (IHD) is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spectrum of IHD expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syndromes (ACS) including unstable angina, acute myocardial infarction (non-ST elevation myocardial infarction and ST elevation myocardial infarction). Stable IHD (SIHD) refers to patients with known or suspected IHD who have no recent or acute changes in their symptomatic status, suggesting no active thrombotic process is underway. These patients include those with i) recent-onset or stable angina or ischemic equivalent symptoms, such as dyspnea or arm pain with exertion; ii) post-ACS stabilized after revascularization or medical therapy; and iii) asymptomatic IHD diagnosed by abnormal stress tests or imaging studies. This review summarizes clinical features and management of SIHD in the older adult. ACS in older adults is not considered in this review.     

磁共振心肌灌注成像对老年冠心病的诊断价值

目的　探讨磁共振心肌灌注成像对老年冠心病的诊断价值。方法　对临床确诊的 35例冠心病患者 ,利用磁共振心肌灌注成像方法得到心肌灌注时间 -信号强度曲线 ,观察曲线的上升斜率和信号强度的峰值。并同期作了冠脉造影 ,确定心肌异常改变与冠脉病变血管分布相对应关系。结果　 33例经心肌灌注成像有 41个病灶呈低灌注区为心肌缺血 ,其中 5例出现延迟强化为心肌梗死 ,经冠脉造影证实 35例均有不同程度的冠脉狭窄。结论　磁共振心肌灌注成像与冠脉造影检查结果无明显差异 ,具有高度的一致性。而磁共振心肌灌注成像是一种无创性测定心肌血流的检查方法 ,为及时诊断及恰当治疗冠心病提供可靠的依据     

Positron emission tomography in clinical cardiology

Positron emission tomography of the heart is a physiologic imaging technique that enables both qualitative and quantitative assessment of regional myocardial blood flow and substrate utilization. Exercise or dipyridamole perfusion imaging with PET is both sensitive and specific for detecting coronary disease and may prove clinically useful in assessing the physiologic significance of anatomically defined stenoses and for noninvasively following stenosis progression or regression. PET can be used to localize and quantitate the extent of antecedent myocardial infarction, and frequently identifies viable tissue when routinely utilized clinical tests indicate completed infarction. The tissue characterization afforded by metabolic imaging with PET in coronary heart disease allows non-invasive identification of viable but jeopardized tissue in a variety of clinical ischemic syndromes, thereby permitting the cardiologist to intervene in anticipation of myocardial salvage. As future developments in PET imaging occur, our understanding of the basic biochemical abnormalities characterizing myocardial ischemia will be utilized with increasing frequency to improve the clinical care provided to patients with coronary heart disease.