臨床心血管分子顯像

臨床心血管分子顯像何作祥心血管病國(guó)家重點(diǎn)實(shí)驗(yàn)室國(guó)家心血管病中心中國(guó)醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院全國(guó)核醫(yī)學(xué)分子影響進(jìn)展高級(jí)研討會(huì)國(guó)家心血管病中心心血管病國(guó)家重點(diǎn)實(shí)驗(yàn)室：研究方向心血管疾病的早期預(yù)警、診斷和治療研究分子影像危重心血管疾病創(chuàng)新技術(shù)——細(xì)胞治療與生物醫(yī)學(xué)工程研究心血管疾病預(yù)測(cè)、評(píng)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