核心脏病学非灌注显像技术的临床应用进展

描述了核心脏病学非灌注显像技术的应用进展，着重探讨其提供的独特的临床信息，并与其它相关显像技术作比较，以扬长避短，同时，对其未被充分应用的因素分析，以期引起人们关注。     

中国核心脏病学三十年回顾

核心脏病学是一门新兴的学科,中国的核心脏病学从20世纪80年代早期兴起,经历了由发展到逐渐成熟的阶段.目前全国已有近200家医院开展核素心肌显像,检测心肌存活,测定心功能以及进行体外检测等,成为心血管疾病无创性检查的重要方法之一.核心脏病学在30年的发展中其内容发生了重大的变化,由上世纪80年代初期的y相机模拟影像进入到目前数字化三维断层显像（SPECT,PET/CT） 由定性诊断发展到定量诊断 由早期功能影像进入到目前的分子影像,由心肌灌注显像（myocardial perfusion imaging,MPI）到目前的心肌代谢显像、心脏受体显像和细胞凋亡显像等,这充分展现了中国核心脏病学发展历程.     

核心脏病学的应用进展

核心脏病学在技术上取得了一定的新进展。在冠心病诊断中核心脏病学检查与其他心脏影像学检查方法各有其优、缺点,彼此相互补充、不能替代。核心脏学检查在冠心病的诊断、危险度评估分层和治疗方案的确定提供了一站式的服务。对于特定人群的冠心病筛查,核心脏病学检查具有特殊的价值。     

核心脏病学研究进展

核心脏病学２０多年来已取得了明显的进展，主要表现在以下几个方面：①ＳＰＥＣＴ显像取代了平面显像，大大提高了图像的对比分辨率（ｃｏｎｔｒａｓｔｒｅｓｏｌｕｔｉｏｎ），减少了组织重叠的影响；②ＰＥＴ的进一步完善与发展，可量化心肌存活测定与心肌灌注显像；...     

放射性核素显像在心力衰竭中的应用

放射性核素显像在测定心室功能，评价心力衰竭的严重程度，了解心肌血流灌注、心肌活力及心脏交感神经功能，鉴别心力衰竭的病因，判断预后，指导临床治疗和评估疗效等多方面都有重要的临床价值。     

有关核心脏病学中的若干问题探讨

介绍了目前核心脏病学中存在的几个问题，重点讨论了心肌显像剂＾９９ｍＴｃ－ＭＩＢＩ，＾９９ｍＴｃ－ｔｅｒｏｆｏｓｍｉｎ，＾９９ｍＴｃ－ｔｅｂｏｒｏｘｉｍｅ和核心脏病学在冠心病后的估价，心肌再灌注，充血性心力衰竭中的临床应用情况。     

PET在介入性心脏病学中的作用

随着ＰＥＴ可以从分子水平反应体内的功能和代谢情况，准确地鉴别存活和坏死心肌，为心脏病的创伤性或非创伤性诊疗提供依据，从而提高了ＰＴＣＡ、ＣＡＢＧ等介入治疗的有效率和成功率。     

核心脏病学非灌注显像技术的临床应用进展

描述了核心脏病学非灌注显像技术的应用进展,着重探讨其提供的独特的临床信息,并与其它相关显像技术作比较,以扬长避短.同时,对其未被充分应用的因素进行分析,以期引起人们的关注.     

充血性心力衰竭药物治疗评价

充血性心力衰竭(Congestive Heart Failure．CHF)是临床一个综合症，各种心脏病的晚期，由于病情发展恶化，使心脏最终丧失生理的代偿功能而造成。CHF的确切定义是由于心肌功能紊乱(特别是心室)而引起的肺循环及体循环静脉系统严重淤血的一种综合征表现。所以说，它不是一个独立的疾病。心肌因各种原因受到损害或心肌应力过度增加(如收缩期或舒张期心室负荷过重)，造成心室扩大，心室肥厚，最后以心室舒缩功能紊乱导致肺循环及静脉系统淤血。     

核医学显像在肿瘤心脏病学中的研究进展

近年来,肿瘤心脏病学成为识别、预防和治疗肿瘤本身及肿瘤治疗引发的心血管并发症的一个新兴领域,并随着患者例数的增加逐渐受到人们的关注。核医学显像在肿瘤心脏病学的研究中发挥了重要作用,其可以帮助早期准确地诊断及监测肿瘤治疗引发的心脏毒性,有效改善肿瘤患者的预后。基于此,笔者对核医学显像在肿瘤心脏病学中的研究进展进行综述。     

卡维地洛治疗慢性心力衰竭的疗效观察

目的　探讨卡维地洛治疗慢性心力衰竭的疗效和安全性。方法　 4 6例慢性心力衰竭患者随机分为治疗组 2 6例、对照组 2 0例。对照组采取心衰的标准治疗 (ACEI、利尿剂和洋地黄 ) ;治疗组在心衰标准治疗基础上加用卡维地洛。治疗 6个月 ,观察治疗前后心功能、超声心动图变化及不良反应。结果　卡维地洛平均剂量为 (2 5 .14± 3.0 5 )mg d。两组治疗后心功能均改善。治疗组左室舒张末径减小[(5 8.79± 8.99)mm比 (6 4 .6 8± 10 .12 )mm ,P <0 .0 5 ],左室射血分数明显增加 [(33.72± 11.18) %比(4 3.86± 10 .78) % ,P <0 .0 1],与对照组比较差异有统计学意义 (P <0 .0 5 )。卡维地洛不良反应主要为头昏、乏力、心动过缓和低血压 ,仅 1例不能耐受 5mg d的剂量而退出。未引起肝、肾功能损害及血象、血脂、电解质和糖代谢变化。结论　卡维地洛在心衰标准用药基础上治疗慢性心力衰竭有效、安全 ,能干预左室重塑     

Etiology and pathophysiology of new-onset heart failure: Evaluation by myocardial perfusion imaging

Objective  The IMAGING in Heart Failure study was a prospective, multi-national trial designed to explore the role of single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) as an initial investigative strategy in patients hospitalized with new-onset heart failure. Methods  We recruited 201 patients (age 65.3 ± 14.5 years, 43% women) hospitalized with their first episode of heart failure. Rest/stress gated SPECT Tc-99m sestamibi MPI was performed during or within 2 weeks of the index hospitalization, in addition to standard care. Results  SPECT MPI revealed a broad range of ejection fractions with preserved systolic function in 36% of patients. Forty-one percent of patients had normal perfusion. In the remaining patients, perfusion abnormalities were predominantly due to prior myocardial infarction, with extensive ischemia seen only in 6%. Among patients who underwent coronary angiography, SPECT performance characteristics revealed excellent negative predictive value (96%) for extensive coronary artery disease (CAD). In multivariable analyses, the extent of perfusion abnormality and advancing age predicted the presence of extensive CAD. Conclusions  These preliminary data derived from a non-randomized observational cohort suggest potential diagnostic utility of MPI for ischemic LV dysfunction in new-onset HF, and sets the stage for a prospective randomized study to confirm these findings. The results were presented in part at the 2004 Annual Scientific Sessions of the American Society of Nuclear Cardiology, and the American College of Cardiology.     

吡那地尔对压力负荷性心力衰竭大鼠心肌重塑的影响

目的探讨吡那地尔对压力负荷性心力衰竭大鼠心功能及心肌重塑的影响。方法腹主动脉缩窄法建立大鼠压力负荷性心力衰竭模型,40只雄性Wistar大鼠随机分为假手术组（n=10）、手术组（n=20）和吡那地尔组（n=10）。吡那地尔组大鼠从术后4周开始应用KATP开放剂吡那地尔2mg·kg-1·d-1治疗。术后第12周行血流动力学检测动脉收缩压、舒张压,左室内压上升下降最大速率（±dp/dtmax）和左室舒张末压（LVDEP）。酶联免疫吸附法（ELISA）测定血清B型脑钠肽（BNP）、I型胶原和Ⅲ型前胶原氨基末端肽（PⅢNP）浓度。处死大鼠后称量心脏质量,计算心脏重量指数（心脏质量/体质量）。HE染色计算心肌纤维直径。结果①手术组大鼠心脏重量指数和心肌纤维直径均明显升高,吡那地尔组均显著降低;②手术组收缩压、舒张压、LVEDP明显升高,吡那地尔组明显降低;±dp/dtmax在手术组明显降低（P〈0.01）。手术组血清BNP水平明显升高,吡那地尔组虽然也降低,但仍高于假手术组（P〈0.01）;③手术组I型胶原和PⅢNP的血清浓度明显大于假手术组。吡那地尔组均明显降低（P〈0.01）。结论吡那地尔可改善大鼠腹主动脉缩窄术后的心脏肥厚和心肌纤维化,延缓心力衰竭的进展。     

住院患者心力衰竭570例临床分析

目的进一步认识心力衰竭的病因和特点。方法对我科2005年1月～2009年5月住院心衰患者共570例进行分析。结果心力衰竭病因中冠心病排第一位,其次为高血压、心肌病等。结论冠心病、高血压、心肌病成为心力衰竭的主要病因,关注病因对心力衰竭的预防、治疗有指导意义。感染是最常见的发病诱因,必须积极预防。     

托拉塞米治疗慢性心力衰竭临床观察

目的观察托拉塞米治疗慢性心力衰竭的疗效及安全性。方法 118例患者随机分为托拉塞米治疗组及呋塞米组,两组基础用药一致,比较两组治疗后的体重下降、水肿变化、心功能变化及不良反应。结果两组均可使慢性心力衰竭患者体重下降,水肿减轻,心功能改善,两组对比差异无统计学意义;不良反应发生率两组比较差异无统计学意义,但托拉塞米组低钾发生率低于呋塞米组。结论托拉塞米对慢性心力衰竭疗效肯定,可改善心功能,减轻水肿,特别适用于同时存在低钾的慢性心力衰竭的患者。     

Analysis of referral patterns,predictive accuracy,and impact on patient management of myocardial perfusion imaging in a new nuclear cardiology laboratory

BACKGROUND: Most of the published data on myocardial perfusion imaging (MPI) come from large tertiary-referral medical centers with extensive experience in cardiac imaging as well as a large volume of procedures. Whether the results of MPI remain as reliable in new nuclear cardiology laboratories with smaller volumes of procedures is unknown. The purpose of this study was to analyze the referral patterns, predictive accuracy, and impact of MPI on clinical practice in a newly opened nuclear cardiology laboratory. METHODS AND RESULTS: We performed a prospective study on all patients referred for MPI at our nuclear cardiology laboratory during its first year of operation. Patients were followed up for 3 months after the MPI study to determine whether they underwent coronary angiography. The study population consisted of 334 patients. Their mean age was 56 +/- 10 years, and 80% were men. Of the patients, 30% were asymptomatic, 29% had angina, and only 6% had recent acute myocardial infarction or unstable angina. Fifty-one patients (fifteen percent) were subsequently referred for coronary angiography. The positive and negative predictive values of MPI were 91% and 86%, respectively. The presence of reversible perfusion defects (P =.02) and the presence of multiple perfusion defects (P =.01) on MPI were the most important determinants of subsequent referral to coronary angiography. CONCLUSIONS: MPI stress testing retains its high diagnostic accuracy in a new nuclear cardiology laboratory with a relatively small volume of procedures. Furthermore, MPI findings in this population had a strong impact on the clinical practice of the referring physicians in terms of subsequent referral to coronary angiography.     

甲状腺激素在心血管疾病诊断和治疗中的临床应用

目的 探讨甲状腺激素在心血管疾病诊断和治疗中的临床应用.方法 用发光免疫分析法150例冠心病心力衰竭患者,86例急性心肌梗死(AMI)患者,103例肺心病患者和47名我院健康体检者(正常对照组)血清中的甲状腺激素水平.结果 冠心病心力衰竭患者、AMI患者和肺心病患者血清中三碘甲腺原氨酸(T3)、游离三碘甲腺原氨酸(FT3)及T3/反转三碘甲腺原氨酸(rT3)较正常对照组明显降低(t=2.120、2.214、4.356,P均＜0.05),而血清rT3明显增高(t=2.256、4.416、4.512,P均＜0.05).冠心病心力衰竭患者的血清T3、FT3及T3/rT3随心力衰竭的严重程度明显降低;肺心病急发期较缓解期降低明显,rT3则增加明显.冠心病心力衰竭患者、AMI患者和肺心病患者血清中甲状腺素、游离甲状腺素和促甲状腺激素与正常对照组比较无明显差异(t=1.781、1.813、1.754,P均＞0.05).结论 血清T3、FT3和T3/rT3的降低和rT3的增高是诊断冠心病心力衰竭及严重程度、AMI和肺心病急发期或缓解期的有效指标,并具有治疗后随访的临床价值.     

Nuclear medicine studies of the heart

Nuclear imaging techniques are well established diagnostic tools in clinical cardiology, providing noninvasive information about myocardial perfusion, function and metabolism. The cost-effectiveness of radionuclide imaging in the diagnostic work-up of patients with coronary artery disease has been demonstrated. Additionally, the documented prognostic value of scintigraphic parameters is of clinical importance to guide decision making. Advances in technology, new radiotracers and new applications contribute to continuous growth in the field of nuclear cardiology. Multi-headed gamma camera systems lead to higher spatial resolution and sensitivity of cardiac single photon emission tomography (SPECT), and they also provide the opportunity for attenuation correction or electrocardiographic gating of SPECT images. Objective quantitative values of perfusion, function and metabolism are derived from scintigraphic data by use of improved software and hardware. With the latest developments in tracer technology, imaging of myocardial necrosis, receptor systems and autonomic innervation has become a reality and will lead to new clinical applications in the future. Received 12 December 1997; Revision received 16 February 1998; Accepted 18 February 1998     

Value of multidetector computed tomography evaluation of myocardial perfusion in the assessment of ischemic heart disease: comparison with nuclear perfusion imaging

MDCT-derived myocardial perfusion has not yet been validated against accepted standards. We developed a technique for quantification of myocardial perfusion from MDCT images and studied its diagnostic value against SPECT myocardial perfusion imaging (MPI). Ninety-eight patients were studied. Abnormal perfusion was detected by comparing normalized segmental x-ray attenuation against values obtained in 20 control subjects. Disagreement with resting MPI was investigated in relationship to MDCT image quality, severity of MPI abnormalities, and stress MPI findings. Resting MPI detected mild or worse abnormalities in 20/78 patients. MDCT detected abnormalities in 15/20 patients (sensitivity of 0.75). Most abnormalities missed by MDCT analysis were graded as mild on MPI. Additional abnormalities found in 16/78 patients were not confirmed on resting MPI (specificity of 0.72). However, 8 of these 16 apparently false positive MDCT perfusion tests had abnormal stress MPI; of these 8 patients, 7 had optimal MDCT image quality, while in 6/8 remaining patients, image quality was suboptimal. When compared with resting MPI, MDCT detected perfusion abnormalities with high accuracy. Moreover, half of MDCT perfusion abnormalities not confirmed by resting MPI were associated with abnormal stress MPI. Importantly, this information can be obtained without additional radiation dose or contrast agent.