心肌存活與缺血性心肌病

靜息SPECT心肌灌注

+PET心肌代謝顯像評(píng)價(jià)心肌存活孫曉昕MyocardialViabilitySevereWallMotionImpairmentIrreversiblePotentiallyReversible ifbloodflowrestoredMyocardialHibernationMyocardialStunningLVEF37%LVEDV128mlLVEF76%LVEDV104ml8monthsafterLADgraftReversibleWallMotionImpairmentandResponsetoRevascularizationafterRahimtoola血運(yùn)重建術(shù)

對(duì)左心功能衰竭患者的影響如果梗死部位有一定數(shù)量的存活心肌改善局部和/或左心整體功能阻止心臟的擴(kuò)大和左室重構(gòu)改善心衰癥狀提高運(yùn)動(dòng)耐受性改善患者近期及長(zhǎng)期預(yù)后如果無存活心肌，術(shù)后心功能改善的可能性小，而且手術(shù)的死亡率隨射血分?jǐn)?shù)的減低而增加(<35%,約8%,>50%,約2%)。冠狀動(dòng)脈微循環(huán)（尸檢）冠狀動(dòng)脈造影SPECT心肌灌注-PET心肌代謝

心肌存活心肌梗死正常不匹配匹配臨床應(yīng)用冠心病，心肌梗死后，冬眠心肌的評(píng)價(jià)冠脈起源異常，心肌血流灌注受損情況及冬眠心肌的評(píng)價(jià)秦**，男，55歲。間斷胸悶、氣短1月余，加重伴反復(fù)暈厥2天。入院診斷：CAD，AMI(非ST抬高)，OMI（下壁），PCI術(shù)后，室速，室顫，CPR術(shù)后2018-8-8進(jìn)行靜息灌注+PET-CT心肌代謝顯像。

Revascularization

inSevereLeftVentricularDysfunction:DoesMyocardial

Viability

EvenMatter?

Annualmortalityrateinpatientswithandwithoutmyocardialviabilitytreatedwithrevascularizationvsmedicaltherapy(Meta-analysisbyAllmanetal).ClinMedInsightsCardiol.

2015Jun28;9(Suppl1):105-9.QuantitativeRelationBetweenMyocardialViabilityandImprovementinHeartFailureSymptomsAfterRevascularizationinPatientsWithIschemicCardiomyopathy(1)Circulation.

1995Dec15;92(12):3436-44.13Nammoniaand18F-FDGPETScatterplotshowingtherelationbetweentheflow–metabolismmismatches,andthechangeinfunctionalstatusgrade(SpecificActivityScale)afterCABG,expressedaspercentimprovementfrombaseline.Therelationwasy=24.27+2.04x,

r=.87,SEE=10.8,

P<.001.Thisoperatingpointwasassociatedwithasensitivityof76%andaspecificityof78%forpredictinganimprovementinfunctionalclassofatleastone.ScatterplotofchangesinMETSofactivityafterCABG(Follow-up)groupedbyanatomicextentofbloodflow–metabolismmismatch(ie,groupA,<5%;groupB,5–17%;andgroupC,≥18%).Pre-opindicatespreoperative.QuantitativeRelationBetweenMyocardialViabilityandImprovementinHeartFailureSymptomsAfterRevascularizationinPatientsWithIschemicCardiomyopathy(2)臨床應(yīng)用冠心病，心肌梗死后，冬眠心肌的評(píng)價(jià)冠脈起源異常，心肌血流灌注受損情況及冬眠心肌的評(píng)價(jià)F,16m,左冠起源于肺動(dòng)脈，右冠→側(cè)支→左冠→肺動(dòng)脈M,9m,左冠脈起源于肺動(dòng)脈，左冠→肺動(dòng)脈M,8m