Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Semin Nucl Med. 2014 Jul;44(4):294-313. doi: 10.1053/j.semnuclmed.2014.04.005.
Heart failure (HF) is a major problem, with a high prevalence, morbidity, mortality, and cost, and is expected to become more widespread. Radionuclide imaging currently plays an important role in evaluating these patients, with much potential for increased utility. Myocardial perfusion imaging (MPI) with radiotracers is commonly used to differentiate an ischemic from a nonischemic etiology of HF and cardiomyopathy. In some instances, MPI effectively distinguishes among these, but often, standard MPI is deficient in that a nonischemic cardiomyopathy can have focal defects in tracer uptake and coronary artery disease with global balanced ischemia can result in a normal-appearing perfusion pattern. Developments in measuring quantitative blood flow promise to provide a more accurate determination of HF etiology. If coronary artery disease is established, MPI has long established use for assessment of myocardial viability and identification of patients likely to benefit from revascularization. Although a recent multicenter trial substudy has questioned the benefits of viability imaging, specific limitations of this study must be balanced against previously demonstrated utility. At the same time, viability imaging may need to be directed more skillfully toward carefully selected patients. In patients with HF who are not candidates for revascularization, myocardial remodeling often leads to poor patient outcome. Newer nuclear analyses of myocardial shape and of dyssynchronous contraction or relaxation can risk stratify patients and may help guide therapy. Investigative molecular imaging techniques promise to better understand underlying pathophysiology and guide therapy on an individual basis. Finally, recent approval of a tracer for cardiac autonomic innervation imaging should greatly expand the use of radionuclide imaging in HF, potentially guiding proper use of life saving but expensive and high-risk mechanical therapies. Given the molecular basis of much of the pathophysiology of HF, the contribution of cardiac radionuclide imaging to improve patient care should increase.
心力衰竭（HF）是一个主要问题，具有高患病率、发病率、死亡率和成本，预计将更为普遍。放射性核素成像目前在评估这些患者方面发挥着重要作用，具有更大的应用潜力。放射性示踪剂心肌灌注成像（MPI）常用于区分心力衰竭和心肌病的缺血性和非缺血性病因。在某些情况下，MPI 可以有效地进行区分，但通常情况下，标准 MPI 存在缺陷，即非缺血性心肌病可能在示踪剂摄取方面存在局灶性缺陷，而伴有全球平衡缺血的冠状动脉疾病则会导致正常的灌注模式。测量定量血流的新进展有望为心力衰竭病因的更准确确定提供依据。如果确定存在冠状动脉疾病，MPI 长期以来一直用于评估心肌活力并确定可能受益于血运重建的患者。尽管最近的一项多中心试验亚研究对存活能力成像的益处提出了质疑，但必须权衡该研究的具体局限性与先前证明的实用性。同时，存活能力成像可能需要更巧妙地针对精心挑选的患者。对于不适合血运重建的心力衰竭患者，心肌重构通常会导致患者预后不良。心肌形状和收缩或舒张不同步的新核分析可以对患者进行风险分层，并可能有助于指导治疗。研究性分子成像技术有望更好地了解潜在的病理生理学，并根据个体情况指导治疗。最后，心脏自主神经支配成像示踪剂的最近批准应大大扩展心力衰竭中放射性核素成像的应用，可能指导适当使用救生但昂贵且高风险的机械治疗。鉴于心力衰竭的大部分病理生理学都具有分子基础，心脏放射性核素成像对改善患者护理的贡献应该会增加。
