Elfigih Iqbal A, Henein Michael Y
Canterbury Christ Church University, Canterbury, UK.
Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Int J Cardiol Heart Vasc. 2014 Oct 18;5:51-56. doi: 10.1016/j.ijcha.2014.10.008. eCollection 2014 Dec.
Coronary artery disease (CAD) is the most prevalent and single most common cause of morbidity and mortality [1] with the resulting left ventricular (LV) dysfunction an important complication. The distinction between viable and non-viable myocardium in patients with LV dysfunction is a clinically important issue among possible candidates for myocardial revascularization. Several available non-invasive techniques are used to detect and assess ischemia and myocardial viability. These techniques include echocardiography, radionuclide images, cardiac magnetic resonance imaging and recently myocardial computed tomography perfusion imaging. This review aims to distinguish between the available non-invasive imaging techniques in detecting signs of functional and perfusion viability and identify those which have the most clinical relevance in detecting myocardial viability in patients with CAD and chronic ischemic LV dysfunction. The most current available studies showed that both myocardial perfusion and function based on non-invasive imaging have high sensitivity with however wide range of specificity for detecting myocardial viability. Both perfusion and function imaging modalities provide complementary information about myocardial viability and no optimum single imaging technique exists that can provide very accurate diagnostic and prognostic viability assessment. The weight of the body of evidence suggested that non-invasive imaging can help in guiding therapeutic decision making in patients with LV dysfunction.
冠状动脉疾病(CAD)是最普遍且是发病和死亡的单一最常见原因[1],由此导致的左心室(LV)功能障碍是一个重要的并发症。在左心室功能障碍患者中,存活心肌与无存活心肌之间的区分是心肌血运重建可能候选者中一个重要的临床问题。有几种可用的非侵入性技术用于检测和评估缺血及心肌存活情况。这些技术包括超声心动图、放射性核素成像、心脏磁共振成像以及最近的心肌计算机断层扫描灌注成像。本综述旨在区分现有的非侵入性成像技术在检测功能和灌注存活迹象方面的差异,并确定那些在检测CAD和慢性缺血性左心室功能障碍患者心肌存活方面具有最大临床相关性的技术。最新的现有研究表明,基于非侵入性成像的心肌灌注和功能对检测心肌存活均具有高敏感性,但特异性范围较宽。灌注和功能成像模式都提供了关于心肌存活的互补信息,不存在能够提供非常准确的诊断和预后存活评估的最佳单一成像技术。大量证据表明,非侵入性成像有助于指导左心室功能障碍患者的治疗决策。