Cardiac PET Imaging for the Detection and Monitoring of Coronary Artery Disease and Microvascular Health
Cardiac PET Imaging for the Detection and Monitoring of Coronary Artery Disease and Microvascular Health
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DOI：
10.1016/j.jcmg.2010.04.007
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发表时间：
2010-06-01
影响因子：
14
通讯作者：
Dilsizian, Vasken
中科院分区：
文献类型：
--
作者：
Schindler, Thomas H.;Schelbert, Heinrich R.;Dilsizian, Vasken
正电子发射断层扫描（PET）心肌灌注成像与示踪剂动力学建模相结合，以绝对值（毫升/克/分钟）评估左心室的局部心肌血流量（MBF）。在静息状态和各种形式的血管紧张性应激期间评估MBF可无创地了解冠状动脉血管功能和/或结构的早期和亚临床异常。MBF和心肌血流储备（MFR）的非侵入性评估和定量将常规心肌灌注成像的范围从检测终末期、晚期和血流限制性心外膜冠状动脉疾病（CAD）扩展到早期动脉粥样硬化或微血管功能障碍。最近的研究表明，充血性MBF或MFR与PET受损，伴或不伴CAD，是死亡或心力衰竭进展的相对风险增加的预测。通过PET测量MBF的定量方法可识别多支CAD，并提供监测对生活方式和/或危险因素改变以及治疗干预的反应的机会。充血MBF和/或MFR的改善或正常化是否会转化为长期心血管结局的改善，仍未经临床检验。同时，PET的MBF绝对测量值可用作冠状动脉血管健康的替代标记物，并监测治疗干预。虽然PET心肌灌注评估已成为心脏研究中不可或缺的工具，但在临床实践中仍未得到充分利用。个性化的图像引导心血管治疗可能会在不久的将来改变这种模式。（美国科尔心脏病学杂志2010; 3：623-40）（C）美国心脏病学会基金会2010年
Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer-kinetic modeling affords the assessment of regional myocardial blood flow (MBF) of the left ventricle in absolute terms (milliliters per gram per minute). Assessment of MBF both at rest and during various forms of vasomotor stress provides insight into early and subclinical abnormalities in coronary arterial vascular function and/or structure, noninvasively. The noninvasive evaluation and quantification of MBF and myocardial flow reserve (MFR) extend the scope of conventional myocardial perfusion imaging from detection of end-stage, advanced, and flow-limiting, epicardial coronary artery disease (CAD) to early stages of atherosclerosis or microvascular dysfunction. Recent studies have shown that impaired hyperemic MBF or MFR with PET, with or without accompanying CAD, is predictive of increased relative risk of death or progression of heart failure. Quantitative approaches that measure MBF with PET identify multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. Whether improvement or normalization of hyperemic MBF and/or the MFR will translate to improvement in long-term cardiovascular outcome remains clinically untested. In the meantime, absolute measures of MBF with PET can be used as a surrogate marker for coronary vascular health, and to monitor therapeutic interventions. Although the assessment of myocardial perfusion with PET has become an indispensable tool in cardiac research, it remains underutilized in clinical practice. Individualized, image-guided cardiovascular therapy may likely change this paradigm in the near future. (J Am Coll Cardiol Img 2010; 3: 623-40) (C) 2010 by the American College of Cardiology Foundation