核心脏病学在心力衰竭中的临床应用

核心脏病学的显像技术是一种常用的无创的诊断心力衰竭的重要手段，在评估心力衰竭程度和指导心力衰竭治疗方面发挥了重要作用。定量门控SPECT心肌灌注显像借助其定量分析软件，可以定量评价心脏容积、左心室射血分数、每搏输出量、心脏舒张功能。静息和（或）负荷心肌灌注显像不仅能鉴别非缺血性心力衰竭和缺血性心力衰竭，而且能判别心肌是否存在活性。核心脏病显像技术能轻易地鉴别出舒张性心力衰竭（也称为射血分数正常的心力衰竭），它通过高峰充盈率和高峰充盈率时间可以准确地评估舒张性心力衰竭的程度。借助三维成像等新技术定量门控SPECT能有效评估左室运动情况，评估室壁厚度对其是一个很好的补充。心肌灌注显像还常用于判别患者是否适合植入心脏除颤器及是否适合进行心脏再同步化治疗。123I-间碘苄胍神经递质显像能为心力衰竭患者提供预后信息。心肌代谢活动与其功能密切相关，能量代谢底物是评价药物治疗是否有助于提高心力衰竭患者心功能的一个指标，123I-15-(p-碘苯基)3-R，S-甲基十五烷酸是一种临床研究中常用的心肌代谢显像示踪剂。借助新示踪剂的应用，包括神经递质显像和心肌代谢显像在内的核心脏病学显像技术常用来完善心力衰竭的诊断。核心脏病学显像技术在诊断心力衰竭及指导临床治疗方面做出了巨大贡献。

Clinical use of nuclear cardiology in the assessment of heart failure

Nuclear cardiology is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays an important role in their assessment and management.Quantitative gated single positron emission computed tomography is used to assess quantitatively cardiac volume, left ventricular ejection fraction, stroke volume, and cardiac diastolic function.Resting and stress myocardial perfusion imaging can not only identify nonischemic heart failure and ischemic heart failure, but aslo demonstrat myocardial viability.Diastolic heart failure aslo termed as heart failure with a preserved left ventricular ejection fraction is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate and time to peak filling rate.With newer techniques such as three-dimensional, quantitative gated single positron emission computed tomography can assess movement of the left ventricle, and wall thickening evaluation aids its assessment.Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies.Neurotransmitter imaging using 123I-metaiodobenzylguanidine offers prognostic information in patients with heart failure.Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure.Cardiac metabolic imaging using 123I-15-(p-iodophenyl) 3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure.Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to improve heart failure diagnosis.Nuclear cardiology techniques contribute significantly to identifying patients with heart failure and to guiding their management decisions.