University of Alberta, Edmonton, Alberta, Canada.
Curr Opin Cardiol. 2011 Mar;26(2):132-43. doi: 10.1097/HCO.0b013e32834380e7.
Transthoracic echocardiography (ECHO) and single-photon emission computed tomography (SPECT) are routine in many heart failure patients. Recently, other imaging tests have emerged in heart failure management: cardiovascular magnetic resonance (CMR), positron emission tomography (PET) and computed tomography (CT). This article reviews recent developments in heart failure imaging.
Longitudinal left ventricular systolic strain on ECHO speckle tracking imaging detects subclinical cardiomyopathy and predicts survival in symptomatic heart failure. Late gadolinium enhancement for myocardial scar is an independent predictor of death or transplantation in ischemic and nonischemic cardiomyopathy. In contrast to earlier reports, both ECHO and CMR contrast have a negligible risk of adverse outcomes. Stress perfusion imaging (SPECT or PET) and PET flow quantification have prognostic value in ischemic cardiomyopathy. F-2-fluoro-2-deoxyglucose (FDG) PET directed management can impact outcome. Abnormal myocardial neuronal activity on I-metaiodobenzylguanidine (MIBG) imaging is associated with increased risk of ventricular arrhythmias and death. Cardiac CT potentially could assess heart failure etiology through coronary angiography and myocardial tissue characterization but its precise role remains undetermined.
There have been several exciting developments in all imaging modalities. Large multicenter trials such as IMAGE heart failure are required to standardize measures and establish benefit before widespread use in heart failure can be recommended.
经胸超声心动图（ECHO）和单光子发射计算机断层扫描（SPECT）在许多心力衰竭患者中是常规检查。最近，心力衰竭管理中出现了其他影像学检查：心血管磁共振（CMR）、正电子发射断层扫描（PET）和计算机断层扫描（CT）。本文综述了心力衰竭影像学的最新进展。
ECHO 斑点追踪成像的左心室纵向收缩应变可检测亚临床心肌病，并预测有症状心力衰竭患者的生存率。心肌瘢痕的钆延迟增强是缺血性和非缺血性心肌病患者死亡或移植的独立预测因素。与早期报告相反，ECHO 和 CMR 对比剂的不良事件风险可忽略不计。应激灌注成像（SPECT 或 PET）和 PET 流量定量在缺血性心肌病中有预后价值。氟代脱氧葡萄糖（FDG）PET 指导管理可影响结局。I-间碘苄胍（MIBG）成像上异常的心肌神经元活性与室性心律失常和死亡风险增加相关。心脏 CT 可能通过冠状动脉造影和心肌组织特征评估心力衰竭的病因，但确切作用仍不确定。
所有影像学检查都有一些令人兴奋的进展。需要进行大型多中心试验，如 IMAGE 心力衰竭试验，以标准化措施并在广泛推荐用于心力衰竭之前确定获益。
