Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
University Heart Centre Graz, Graz, Austria.
JACC Cardiovasc Imaging. 2017 Mar;10(3):354-364. doi: 10.1016/j.jcmg.2016.12.011.
Cardiac imaging procedures are a cornerstone of the diagnosis and management of patients with cardiac disease. The optimal management of the patient with stable ischemic heart disease or ischemic heart failure often rests on the totality of symptom burden, patient risk, and disease severity, whether assessed anatomically or functionally. Recent trials have demonstrated the power of flow measurements to direct revascularization as well as the strengths and limitations of ischemia and viability/hibernation imaging as markers of risk to direct interventions. They have also highlighted the challenges in evaluating imaging or functional testing to direct therapies, because imaging does not directly affect outcome itself, rather it affects the management decisions that may result in a positive outcome. Ongoing studies with randomized designs, such as FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation), ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), and AIMI-HF (Alternative Imaging Modalities in Ischemic Heart Failure) (IMAGE-HF [Imaging Modalities to Assist with Guiding Therapy in The Evaluation of Patients with Heart Failure]), will provide the highest level of evidence to support practice changes that may further clarify the role of cardiac imaging in the evaluation of these patients and result in improved patient outcomes.
心脏影像学检查是心脏病患者诊断和治疗的基石。稳定型缺血性心脏病或缺血性心力衰竭患者的最佳治疗通常取决于症状负担、患者风险和疾病严重程度的综合评估，无论是通过解剖学还是功能学评估。最近的临床试验表明，血流测量在指导血运重建方面的作用，以及缺血和存活/冬眠成像作为风险标志物指导干预的优势和局限性。它们还突出了评估影像学或功能测试以指导治疗的挑战，因为影像学本身不会直接影响结果，而是会影响可能产生积极结果的管理决策。正在进行的随机设计研究，如 FAME 3（血流储备分数与血管造影多血管评估）、ISCHEMIA（比较医疗和介入方法的国际健康效果研究）和 AIMI-HF（缺血性心力衰竭的替代成像模式）（IMAGE-HF [成像模式以辅助心力衰竭患者治疗评估中的指导治疗]），将提供最高水平的证据，以支持可能进一步阐明心脏影像学在这些患者评估中的作用的实践改变，并改善患者的预后。
