心力衰竭的放射性核素显像评价.ppt
心力衰竭的放射性核素显像评价,何作祥国家心血管病中心心血管病国家重点实验室中国医学科学院阜外心血管病医院,第三届全国心血管疾病检验及影像诊断学论坛,2012,Myocardial Perfusion,Gated SPECT,Wang F,et al.Eur J Nucl Med Mol Imaging,2009,Regional wall motion in DCM by gatedSPECT and cardiac MRI(n=36),Wang F,et al.Eur J Nucl Med Mol Imaging 2009;36:16111621,Left ventricular function:MUGA,left lateral,LAO,anterior,Positron-labeled tracer analogs for either fatty acids or glucose,Taegtmeyer H,J Nucl Med 2010;51:80S87S,Myocardial Viability,Clinical anginaPET(gold standard)MRIThalliumDobutamine Echo,Guludec DL,Eur J Nucl Med Mol Imaging(2008)35:17091724,Myocardial SPECT and PET/CT Imaging,Sestamibi,FDG,Sestamibi,FDG,Sestamibi,FDG,Myocardial SPECT and PET/CT Imaging,Sestamibi,FDG,Sestamibi,FDG,Sestamibi,FDG,Myocardial SPECT and PET/CT Imaging,QPS,QGS,7,7,7,8,8,10,13,14,17,23,21,16,14,13,13,10,10,20,Survival in Patients with PET“Mismatch”,From Di Carli et al.Am J Cardiol 1994;73:527.,RevascularizationMedical Therapy,Low Rank2=4.60p=0.03,Months of Follow-Up,Cumulative Survival,PET Imaging Patterns and Mortalityin Patients with CAD and LV Dysfunction,Myocardial Viability and Impact of Revascularisation in Patients with CAD Disease and LV Dysfunction:A Meta-Analysis,Allman KC,Shaw LJ,Hachamovitch R,Udelson J,JACC,2002,-58.4%,Viable,Non-viable,Viable,Non-viable,REVASCULARISED,MEDICAL THERAPY,p0.0001,p0.001,158%,Number of studies=24N=3,088EF=32%8%FU 25 10 Mths,Death Rate(%/Yr),Abraham1 A,J Nucl Med 2010;51:567574,Adjusted survival curves for PET and standard arms in Ottawa-FIVE substudy,Contrast MRI vs.FDG SPECT,Liu Q,et al.Nucl Med Comm 2009,SPECT,MRI,Perfusion SPECT and FDG PET in DCM and HF,Sestamibi,FDG,Sestamibi,FDG,Sestamibi,FDG,QPS,QGS,Myocardial SPECT and PET/CT Imaging,Gated perfusion SPECT and FDG PET in HF and LBBB,Sestamibi,FDG,Sestamibi,FDG,Sestamibi,FDG,Perfusion/Metabolism mismatch in DCM,Neglia D,Pharmacologic Reports 2005;57(suppl):151-155,Dipyridamole-induced mismatch using 13N-NH3/18F-FDG PET in patients with IDC,Altehoefer C.LBBB:challenging our concept of metabolic heart imaging with fluorine-18-FDG and PET?J Nucl Med 1998;39:263265.,Kaplan-Meier survival according to the presence of Mismatch in DCM,J Nucl Cardiol 2009;16:76974,BMI and rest myocardial perfusion defect predicts cardiac death in pts with chronic HF,Cai M,et al.Int J Cardiovasv Imaging 2012,123I-MIBG AND CHF,Metaiodobenzilguanidine(MIBG)is an analogue of the false neurotransmitter guanetidine,a potent neuron blocking agent that acts selectively on sympathetic nerves.MIBG and noradrenaline have a similar molecular structure and share the same uptake and storage mechanisms in the sympathetic nerve endings.MIBG is not metabolized by monoamine oxidase;thus,localization of MIBG relates to the presence of sympathetic nerves and to tissue noradrenaline content.MIBG is currently labelled with 123-I for diagnostic purposes and with 131-I for therapy,28/11/2006EF=13%EDV=350 ml,10/07/2007EF=60%EDV=110 ml,Eur J Nucl Med molecular Imaging,2009;36:2068,I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in HF Pts,Agostini D.Eur J Nucl Med Mol Imaging(2008)35:535546,Jacobson AF,et al.J Am Coll Cardiol.2010 May 18;55(20):2212-21,2-Year Cardiac Death and All-Cause Mortality Rates,Jacobson AF,et al.J Am Coll Cardiol.2010 May 18;55(20):2212-21,Cumulative Event Curves in Relation to BNP,LVEF,and H/M,Jacobson AF,et al.J Am Coll Cardiol.2010 May 18;55(20):2212-21,Cumulative Event Curves in Relation to BNP,LVEF,and H/M,Jacobson AF,et al.J Am Coll Cardiol.2010 May 18;55(20):2212-21,HSV-ttk报告基因干细胞PET成像,Li Z,et al.Stem Cells.2008;26:864-873.PLoS ONE.2009;4:e8443.J Am Coll Cardiol.2009;53:1229-40.,Influence of intracoronary stem cell therapy on LVEF,infarct area,and FDG metabolism in PET study,Modified from Strauer et al.JACC Vol.46,No.9,2005,Regeneration of Human Infarcted HeartMuscle by Intracoronary Autologous Bone MarrowCell Transplantation in Chronic CAD:The IACT Study,Strauer et al.JACC Vol.46,No.9,2005,Dilated Cardiomyopathy Due to Doxorubicin/Anthracycline Cardiotoxicity,RNA is an ideal noninvasive tool to provide longitudinal quantitative assessment of LV function in patients receiving doxorubicin and other anthracyclines such as epirubicin.EF should be measured in all patients before receiving doxorubicin;those with pre-existing heart disease and/or LV dysfunction are at greater risk of congestive heart failure.,Thank you,
