Giordano A, Calcagni M L, Verrillo A, Maccafeo S
Istituto di Medicina Nucleare, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
Rays. 1999 Jan-Mar;24(1):73-80.
From over ten years, the assessment of myocardial viability in akinetic zones (stunned or hibernating myocardium) is considered fundamental to the correct management of postinfarction patients. The assessment can be performed with myocardial scintigraphy (201Thallium rest-redistribution, dobutamine stress echocardiography, MRI, 18F-fluorodeoxyglucose PET). A number of experiences have shown that scintigraphy is very sensitive but poorly specific in the assessment of myocardial akinetic zones with contractile functional recovery after revascularization. However, most recent reports have highlighted that the recovery of contractile function is not the single purpose of myocardial revascularization; in fact, it is able to prevent or attenuate remodeling, the contractile reserve is maintained or enhanced, the diastolic function is improved, arrhythmias are prevented, symptoms and functional capacity are improved. Therefore, the role of very sensitive procedures as myocardial scintigraphy or MRI of the heart is still of major diagnostic and prognostic significance. The present socioeconomic situation and the most recent advances in cardiology tend to shift the clinician's interest from the diagnosis to the prognosis of patients with ischemic heart disease and consequently, from maximum diagnostic accuracy to the highest prognostic value and maximum cost/effective benefit. Therefore, the nuclear cardiologist must become familiar with this novel terminology and new diagnostic and prognostic end-points.
十多年来，评估运动减弱区域（顿抑或冬眠心肌）的心肌存活性被认为是对心肌梗死后患者进行正确管理的基础。该评估可通过心肌闪烁显像（铊-201静息-再分布、多巴酚丁胺负荷超声心动图、MRI、18F-氟脱氧葡萄糖PET）来进行。许多经验表明，闪烁显像在评估血管重建后具有收缩功能恢复的心肌运动减弱区域时非常敏感，但特异性较差。然而，最近的报告强调，收缩功能的恢复并非心肌血管重建的唯一目的；事实上，它能够预防或减轻重塑，维持或增强收缩储备，改善舒张功能，预防心律失常，改善症状和功能能力。因此，像心肌闪烁显像或心脏MRI这样非常敏感的检查方法的作用仍然具有重要的诊断和预后意义。当前的社会经济状况以及心脏病学的最新进展倾向于将临床医生的兴趣从诊断转向缺血性心脏病患者的预后，从而从最大诊断准确性转向最高预后价值和最大成本效益。因此，核心脏病学家必须熟悉这种新术语以及新的诊断和预后终点。
