临床心血管分子显像

临床心血管分子显像何作祥心血管病国家重点实验室国家心血管病中心中国医学科学院阜外心血管病医院全国核医学分子影响进展高级研讨会国家心血管病中心心血管病国家重点实验室：研究方向心血管疾病的早期预警、诊断和治疗研究分子影像危重心血管疾病创新技术——细胞治疗与生物医学工程研究心血管疾病预测、评估和人群防控GatedSPECTPET

Myocardial

Perfusion

ImagingCardiacPerfusionandViabilityStudybyPET/CT75yearoldmaleScanprotocol:lowdoseCTforattenuationcorrection PET740MBqNH3,10minutescan,370MBqFDG,10minutescanDataCourtesyofUniversityofMichiganPET/CTallowsaccuratenoninvasiveclinicaldecisionmakingaboutCAD.Becauseofitshighnegativepredictivevalue,PET/CTmayplayanimportantroleinnoninvasiveselectionofCADpatientsforrevascularization.IntegrationofhigherperformancemultislicespiralCTscannersintoPET/CThybridswillacceleratetheclinicalimplementationofthePETtechnique.PET/CTforthediagnosisofCADPET/CTinCADNamdarM,etal.JNM2005DirectImagingofExercise-InducedMyocardialIschemia

WithFluorine-18–LabeledDeoxyglucoseand

Tc-99m-SestamibiinCoronaryArteryDiseaseHeZX,etal.Circulation2003IschemiaIschemiaandScarScarNoabnormality16(31%)6(12%)*3(6%)26(51%)34(67%)0*017(33%)p<0.001ComparisonofabnormalitiesinPtswith≥50%narrowingof≥1coronaryvessels(n=51)99mTc-Sestamibi18FDGHeZX,Circulation.2003;108:1208-1213AbbottBG,etal.NuclMedCommun2007;28:89–94FDGasamemorymarkeroftransientmyocardialischaemia71-y-oldman(patient7)withexertionalangina,90%stenosisofLADand80%stenosisofLCxandRCADouKF,YangMF,etal.JNuclMed2008;49:1986–1991Tl-201SPECT

andFDGPET

inHCMIsobeS,etal.JNuclMed2003;44:1717–1724YamanoM,Heart2009;95:1051StressRestPersistentchestpain;elevatedtroponinlevels;heartrate112bpm,bloodpressure100/50mmHg;LVEF30%,biopsynegativeforhumoralrejectionQuantitativeMBF:Rest0.58ml/min/g;Stress0.86ml/min/g;MBFReserve=1.4616yearoldfemale,2yearsafterhearttransplantMicrovascularDiseaseCourtesyofHenrichSchelbertHeartFailureandCADCADisnowconsideredthepredominantetiologyofheartfailure70%ofpatientsinrecentCHFtrialshadanischemiccardiomyopathyGeorghiade,Circ.1998YusufSetal,Lancet1994MyocardialViabilityClinical–anginaPETMRIThalliumDobutamineEchoLe

GuludecD,EurJNuclMedMolImaging(2008)35:1709–1724VerticalLongAxisSlicesMBFFDGMatchMBFFDGMBFMismatchMBFFDGShortAxisSlicesMismatchHorizontalLongAxisSlicesMBFFDGCourtesyofHenrichSchelbert0.00.20.40.60.81.001224364860Time(months)MedicalCABGp=0.007SurvivalProbabilityWithPETMismatchWithoutPETMismatch0.00.20.40.60.81.001224364860MedicalCABGNSTime(months)SurvivalbyViabilityandTreatmentDiCarlietal,JThorCardiovascSurg1998;116:99793PatientswithIschemicCardiomyopathyandseverelydepressedleftventricularfunction

7778810131417232116141313101020SurvivalinPatientswithPET“Mismatch”FromDiCarlietal.AmJCardiol1994;73:527.04812162024283200.20.40.60.81.0

RevascularizationMedicalTherapyLowRank

2=4.60p=0.03MonthsofFollow-UpCumulativeSurvivalPETImagingPatternsandMortality

inPatientswithCADandLVDysfunctionViableNonviable#MedicalRevasc.MedicalRevasc.Eitzman836/181/262/240/14DiCarli937/173/263/331/17Lee13710/214/492/402/19Total31323/568/1017/973/50Mortality41%8%7%6%FDGIMAGINGINLVANEURYSMSZhangXetalJNuclMed2008;49:1288–129870ptswithLVaneurysm6.8yrsFUSurgeryforviabilityimprovedEFandsurvival(p.0001)Medicaltherapywithviabilityhadworstoutcome(p.0001)MyocardialViabilityandImpactofRevascularisationinPatientswithCADDiseaseandLVDysfunction:AMeta-AnalysisAllmanKC,ShawLJ,HachamovitchR,UdelsonJ,JACC,2002-58.4%ViableNon-viableViableNon-viableREVASCULARISEDMEDICALTHERAPYp<0.0001p<0.001158%Numberofstudies=24N=3,088EF=32%±8%FU25±10MthsDeathRate(%/Yr)SPECTvs.PET

forEvaluationofMyocardialViabilitySensitivity,%Specificity,%SegmentanalysisPET75-9567-84SPECT75-9331-56PatientanalysisPET8288SPECT65-10055-73Tarakji,K.G.etal.Circulation2006;113:230-237Associationbetweenpredicted3-yearmortalityandtheamountofcompromisedviablemyocardiumdeterminedbyPET/FDGstudyaccordingtoperformanceofearlyinterventionamongpropensity-matchedpatientsTarakji,K.G.etal.Circulation2006;113:230-237Propensity-matchedpatientsundergoingPETviabilitytesting(306/765)attheClevelandClinicAdjustedsurvivalcurvesforPETandstandardarmsinOttawa-FIVEandrestofPARR2Abraham1A,JNuclMed2010;51:567–574ACC/AHAGuidelinesfor

PercutaneousCoronaryIntervention

(Revisionofthe1993PTCAGuidelines)RecommendationsforPCIinAsymptomaticorClassIAnginaPatients:ClassIPatientswhodonothavetreateddiabeteswithasymptomaticischemiaormildanginawith1ormoresignificantlesionsin1or2coronaryarteriessuitableforPCIwithahighlikelihoodofsuccessandalowriskofmorbidityandmortality.Thevesselstobedilatedmustsubtendalargeareaofviablemyocardium.Smithetal.JACCVol.37,No.8,2001ClassIindicationFollowinganinconclusiveSPECTscanFordeterminationofmyocardialviabilityasaprimaryorinitialdiagnosticstudypriortorevascularization.*FromAHA/ACCTaskForce,Circulation2002ACC/AHARecommendationforMyocardialViabilityUsingFDGPETRecommendationsfordetectionofmyocardialviabilityinheartfailureIss