五洲會(huì)何作祥核心臟病學(xué)現(xiàn)狀與進(jìn)展a課件

1、五洲會(huì)何作祥核心臟病學(xué)現(xiàn)狀與進(jìn)展a課件五洲會(huì)何作祥核心臟病學(xué)現(xiàn)狀與進(jìn)展a課件Accuracy of Noninvasive Test for Diagnosis of CADNo. of StudiesNo. of PatientsSensitivitySpecificityExercise ECG147240476877Exercise Perfusion Imaging2287518980Pharmacological Stress Scintigraphy 1110008591Circulation 2000;102:126Accuracy of Noninvasive Test f五洲

2、會(huì)何作祥核心臟病學(xué)現(xiàn)狀與進(jìn)展a課件Gupta et al, 1992Gupta et al, 1992心肌灌注顯像正常與異常的冠狀動(dòng)脈再血管化治療比例（N=1053）Patients with a normal stress myocardial perfusion imaging are at low risk for cardiac events (400EBT Baseline Calcium Score% with +SPECT(n=17)(n=37)(n=93)(n=89)(n=10)1-10246 patients allasymptomaticexcept 34 withatyp

3、ical CP58 + 10 years75% with 2 ormore RFHe et. al Circulation 2000;101:244-51EBT Calcium Score and SPECT Thallium Stress Testing0%0%2.7%10.8%48.3%010203040500Clinical Characteristics (N=706) of Patients who Underwent CTA and SPECT13N (%)/averageAge56.19.9Male450 (63.7%)Body Mass Index25.1*Diabetes10

4、2 (14.4)Hypertension388 (55.0)Hyperlipidemia407 (57.6)Smoking273 (38.7)Family History of CAD165 (23.4)SymptomsAsymptomatic118 (16.7)Atypical chest pain476 (67.4)Typical chest pain112 (15.9)Clinical Characteristics (N=70Accuracy of luminal stenosis by coronary CTA for detecting abnormal MPI14Stenosis

5、Sensitivity*Specificity*PPV*NPV*Patients Level50%80.256.721.595.175%48.490.442.792.290%29.798.47390.4Vascular Level50%69.679.315.897.975%40.295.633.696.690%22.39954.395.8Accuracy of luminal stenosis bCTA and SPECT/ CTA for Detection of Hemodynamically Significant Coronary LesionsRispler JACC 2007; 4

6、9: 1059-67050100PercentSens Spec PPV NPVSens Spec PPV NPVCTASPECT/ CTA9696999963953177CTA and SPECT/ CTA for DetectiPET/CT in CADNamdar M, et al. JNM 2005PET/CT in CADNamdar M, et al. Myocardial Infarctions are causedby Low-Grade StenosesPooled data from 4 studies: Ambrose et al, 1988; Little et al,

7、 1988; Nobuyoshi et al, 1991; and Giroud et al, 1992.(Adapted from Falk et al.)Myocardial Infarctions are cauRisk StratificationLow 3% per year Adapted from Gibbons RJ, et al. J Am Coll Cardiol. 1999;33:2092-2197. Risk of Cardiac Death:Risk StratificationLow AdapteRisk Stratification: Noninvasive Te

8、sting Markers Amount of infarcted myocardium Amount of jeopardized myocardium Degree of jeopardy Risk Stratification: NoninvasRisk Stratification: Noninvasive Testing MarkersLeft ventricular systolic function Risk Stratification: NoninvasPredictors of cardiac mortalityfactors estimating the extent o

9、f LV dysfunction LVEFthe extent of infarcted myocardiumtransient ischemic dilation of the LV and increased lung uptakePredictors of cardiac mortalitPredictors of the subsequent development of acute ischemic syndromesmarkers of provocative ischemiaexertional symptoms,electrocardiographic changesthe e

10、xtent of reversible perfusion defectsstress-induced ventricular dyssynergyPredictors of the subsequent d五洲會(huì)何作祥核心臟病學(xué)現(xiàn)狀與進(jìn)展a課件Introduction to Nuclear Medicine心肌灌注顯像正常與異常的冠狀動(dòng)脈再血管化治療比例（N=1053）Stenosis 50% (n=51)1,149 Were included in the primary analysisNamdar M, et al.Yang MF, NMC, 2006Gated SPECT vs.19

11、99;33:2092-2197.Severe CalcificationEBT Baseline Calcium ScoreKaplan-Meier survival for patients by residual ischemiaCirculation 1998EBT Calcium Score and SPECT Thallium Stress Testing75% with 2 orVascular LevelFollow-up Time (Months)9080706050403020100Cumulative Event-Free Survival..5Normal

12、CoronariesAngiographic CADp=nsYang MF, NMC, 2006Introduction to Nuclear MediciPrognostic value: Perfusion imaging vs. AngiographyPatients with a normal stress myocardial perfusion imaging are at low risk for cardiac events (1% mortality per year), even in the presence of angiographically significant

13、 coronary artery stenosis.Prognostic value: Perfusion i Event Rate/Year, % Cardiac Death MI Hachamovitch R, et al. Circulation. 1998;97:535-543.Scan Result*Mildly AbnormalModerately AbnormalSeverely AbnormalNormal2946884455898Prognosis: MPI Scan Severity Predicts Outcome* P.001 *P.01nSSS13 Event Rat

14、e/YeCardiac Death Rate (%/y)Hachamovitch R, et al. Circulation 1998Cardiac Death Rate (%/y)HachamEnrollment and Outcomes3,071 Patients met protocol eligibility criteria2,287 Consented to Participate(74% of protocol-eligible patients)1,149 Were assigned to PCI group 46 Did not undergo PCI 27 Had a le

15、sion that could not be dilated1,006 Received at least one stent784 Did not provide consent- 450 Did not receive MD approval- 237 Declined to give permission- 97 Had an unknown reason107 Were lost to follow-up1,149 Were included in the primary analysis1,138 Were assigned to medical-therapy group97 Were lost to follow-up1,138 Were included in the primary analysisEnrollment and Outcomes3,071 PShaw, L. J. et al. Circulation ;117:1283-1291Kaplan-Meier survival for patients by residual ischemia after 6 to 18 months of PCI+OM