Examine thy heart with all diligence: evaluation of cardiac function using fast computed tomography.
Examine thy heart with all diligence: evaluation of cardiac function using fast computed tomography.
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尽全力检查您的心脏：使用快速计算机断层扫描评估心脏功能。
DOI：
10.1161/01.hyp.0000253086.74365.52
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Lerman,LilachO
中科院分区：
文献类型：
--
作者：
Daghini,Elena;Ritman,ErikL;Lerman,LilachO
心血管疾病是西方社会死亡的主要原因，但其早期可能表现为冠状动脉心外膜或微血管功能的微妙改变，包括内皮功能障碍、灌注或渗透性异常以及重塑，这些可能先于血管疾病的临床表现。这些改变可能与舒张和/或收缩功能的亚临床下降以及左心室（LV）重塑有关。因此，评估心肌灌注和微血管功能以识别持续性缺血或冬眠心肌、内皮或左室功能障碍的区域对于临床决策非常重要，并推动了对评估心脏病不同阶段的无创技术的探索。目前用于探索心脏功能的几种无创或微创技术，如超声心动图、闪烁扫描和单光子发射计算机断层扫描，显示出诊断可靠性，但空间分辨率低且解剖学较差详细信息。因此，更高分辨率的技术，如正电子发射断层扫描、MRI 和计算机断层扫描 (CT)，一直在稳步普及。 1 MRI 可以评估心脏功能、质量、体积和心肌活力，但在有金属碎片的患者中应用有限，而正电子发射断层扫描可以提供心肌灌注和代谢的可靠估计，尽管空间分辨率较低。此外，自 20 世纪 70 年代诞生以来，CT 迅速融入临床实践，最近的技术进步使其处于从心脏作为泵的功能到为心脏壁供血的微血管行为等多个层面综合评估心脏功能的前沿（图 1）。例如，CT克服了MRI的一些局限性，因为它可以研究带有除颤器或起搏器的患者，采集时间更短，并且比正电子发射断层扫描更容易获得和负担得起，从而使更多的患者能够获得心脏成像。
Cardiovascular disease is a major cause of mortality in Western society but at its early phase may manifest as subtle alterations in coronary epicardial or microvascular function, including endothelial dysfunction, abnormal perfusion or permeability, and remodeling, which may precede clinical manifestation of vascular disease. These modifications might be associated with subclinical decline in diastolic and/or systolic function and left ventricular (LV) remodeling. Evaluation of myocardial perfusion and microvascular function to identify areas of persistent ischemia or hibernating myocardium, endothelial, or LV dysfunction is, therefore, important for clinical decision-making and fuels the search for noninvasive techniques assessing different stages of cardiac disease.Several noninvasive or minimally invasive techniques currently used to explore cardiac function, such as echocardiography, scintigraphy, and single-photon emission computed tomography, show diagnostic reliability but low spatial resolution and poor anatomic details. Therefore, higherresolution techniques, like positron emission tomography, MRI, and computed tomography (CT), have been steadily gaining popularity. 1 MRI can assess cardiac function, mass, volume, and myocardial viability, with limited application in patients with metal fragments, and positron emission tomography provides reliable estimates of myocardial perfusion and metabolism, albeit at low spatial resolution. Furthermore, since its inception in the 1970s, CT quickly incorporated into clinical practice, and recent technical advances have placed it in the forefront for comprehensive evaluation of cardiac function at several levels, from the function of the heart as a pump, to the behavior of the microvessels that feed its walls (Figure 1). For example, CT overcomes some of the limitations of MRI, because it can study patients with defibrillators or pacemakers, has a shorter acquisition time, and is more available and affordable than positron emission tomography, thus allowing access to cardiac imaging to a greater number of patients.