五洲会何作祥核心脏病学现状与进展a课件

五洲会何作祥核心脏病学现状与进展a课件本文档共31页；当前第1页；编辑于星期一\23点11分AccuracyofNoninvasiveTestforDiagnosisofCADNo.ofStudiesNo.ofPatientsSensitivitySpecificityExerciseECG147240476877ExercisePerfusionImaging2287518980PharmacologicalStressScintigraphy11<10008591Circulation2000;102:126本文档共31页；当前第2页；编辑于星期一\23点11分本文档共31页；当前第3页；编辑于星期一\23点11分Guptaetal,1992本文档共31页；当前第4页；编辑于星期一\23点11分腺苷负荷试验心肌灌注显像多中心临床试验田月琴,等,中华心血管病杂志,2005本文档共31页；当前第5页；编辑于星期一\23点11分AdenRestAdenRestAdenRest本文档共31页；当前第6页；编辑于星期一\23点11分CanGatedSPECTimprovesensitivityforCADdetection?本文档共31页；当前第7页；编辑于星期一\23点11分Part0.IntroductiontoNuclearMedicine8ECG-GATEDMYOCARDIALPERFUSION本文档共31页；当前第8页；编辑于星期一\23点11分GatedSPECTvs.CineMRIWangF,etal.EurJNuclMedMolImaging,2009本文档共31页；当前第9页；编辑于星期一\23点11分SpecificityofStressTI-201andTc-99mSestamibi

SPECTforCADDetectioninWomenStenosis50%(n=51)Stenosis70%(n=64)p=0.002p=0.0004p=0.05NSp=0.02NSAdaptedfromTailleferetal.JNuclMed1996;37:69P.70.686.394.167.284.492.20102030405060708090100Tl-201Tc-99m

SestamibiGatedTc-99m

SestamibiSpecificity(%)本文档共31页；当前第10页；编辑于星期一\23点11分ExamplesofCoronaryArteryScansNormalConditionModerateCalcificationSevereCalcification本文档共31页；当前第11页；编辑于星期一\23点11分0%0%2.7%10.8%48.3%01020304050011-100101-399>400EBTBaselineCalciumScore%with+SPECT(n=17)(n=37)(n=93)(n=89)(n=10)1-10246patientsallasymptomaticexcept34withatypicalCP58+10years75%with2ormoreRFHeet.alCirculation2000;101:244-51EBTCalciumScoreandSPECTThalliumStressTesting本文档共31页；当前第12页；编辑于星期一\23点11分ClinicalCharacteristics(N=706)ofPatientswhoUnderwentCTAandSPECT13N(%)/averageAge56.1±9.9Male450(63.7%)BodyMassIndex25.1*Diabetes102(14.4)Hypertension388(55.0)Hyperlipidemia407(57.6)Smoking273(38.7)FamilyHistoryofCAD165(23.4)SymptomsAsymptomatic118(16.7)Atypicalchestpain476(67.4)Typicalchestpain112(15.9)本文档共31页；当前第13页；编辑于星期一\23点11分AccuracyofluminalstenosisbycoronaryCTAfordetectingabnormalMPI14StenosisSensitivity*Specificity*PPV*NPV**Patients’Level≥50%80.256.721.595.1≥75%48.490.442.792.2≥90%29.798.47390.4VascularLevel≥50%69.679.315.897.9≥75%40.295.633.696.6≥90%22.39954.395.8本文档共31页；当前第14页；编辑于星期一\23点11分CTAandSPECT/CTAforDetectionofHemodynamicallySignificantCoronaryLesionsRisplerJACC2007;49:1059-67050100PercentSensSpecPPVNPVSensSpecPPVNPVCTASPECT/CTA9696999963953177本文档共31页；当前第15页；编辑于星期一\23点11分PET/CTinCADNamdarM,etal.JNM2005本文档共31页；当前第16页；编辑于星期一\23点11分MyocardialInfarctionsarecaused

byLow-GradeStenosesPooleddatafrom4studies:Ambroseetal,1988;Littleetal,1988;Nobuyoshietal,1991;andGiroudetal,1992.

(AdaptedfromFalketal.)本文档共31页；当前第17页；编辑于星期一\23点11分RiskStratificationLow

<1%peryearIntermediate

1-3%peryearHigh

>3%peryearAdaptedfromGibbonsRJ,etal.JAmCollCardiol.1999;33:2092-2197.RiskofCardiacDeath:本文档共31页；当前第18页；编辑于星期一\23点11分RiskStratification:

NoninvasiveTestingMarkersAmountofinfarctedmyocardiumAmountofjeopardizedmyocardiumDegreeofjeopardy本文档共31页；当前第19页；编辑于星期一\23点11分RiskStratification:

NoninvasiveTestingMarkersLeftventricularsystolicfunction本文档共31页；当前第20页；编辑于星期一\23点11分PredictorsofcardiacmortalityfactorsestimatingtheextentofLVdysfunctionLVEFtheextentofinfarctedmyocardiumtransientischemicdilationoftheLVandincreasedlunguptake本文档共31页；当前第21页；编辑于星期一\23点11分Predictorsofthesubsequent

developmentofacute

ischemicsyndromesmarkersofprovocativeischemiaexertionalsymptoms,electrocardiographicchangestheextentofreversibleperfusiondefectsstress-inducedventriculardyssynergy本文档共31页；当前第22页；编辑于星期一\23点11分本文档共31页；当前第23页；编辑于星期一\23点11分Follow-upTime(Months)9080706050403020100CumulativeEvent-FreeSurvival1.0.9.8.7.6.5NormalCoronariesAngiographicCADp=nsYangMF,NMC,2006本文档共31页；当前第24页；编辑于星期一\23点11分Prognosticvalue:

Perfusionimagingvs.AngiographyPatientswithanormalstressmyocardialperfusionimagingareatlowriskforcardiacevents(<1%mortalityperyear),eveninthepresenceofangiographicallysignificantcoronaryarterystenosis.本文档共31页；当前第25页；编辑于星期一\23点11分

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HachamovitchR,etal.Circulation.1998;97:535-543.ScanResult****MildlyAbnormalModeratelyAbnormalSeverelyAbnormalNormal2946884455898Prognosis:MPIScan

SeverityPredictsOutcome*P<.001**P<.01nSSS<44-89-13>13本文档共31页；当前第26页；编辑于星期一\23点11分CardiacDeathRate(%/y)HachamovitchR,etal.Circulation1998本文档共31页；当前第27页；编辑于星期一\23点11分EnrollmentandOutcomes3,071Patientsmetprotocoleligibilitycriteria2,287ConsentedtoParticipate(74%ofprotocol-eligiblepatients)1,149WereassignedtoPCIgroup46DidnotundergoPCI27Hadalesionthatcouldnotbedilated1,006Receivedatleastonestent784Didnotprovideconsent-450DidnotreceiveMDapproval-237Declinedtogivepermission-97Hadanunknownreason107Werelosttofollow-up1,149Wereincludedintheprimaryanalysis1,138Wereassignedtomedical-therapygroup97Werelosttofollow-up1,138Wereincludedintheprimaryanalysis本文档共31页；当前第28页；编辑于星期一\23点11分Shaw,L.J.etal.Circulation2008;117:1283-1291Kaplan-Meiersurvivalforpatientsbyresidualischemia