Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA.
Ochsner Clinical School, Queensland University School of Medicine, New Orleans, LA, USA.
Curr Cardiol Rep. 2021 Mar 24;23(4):50. doi: 10.1007/s11886-021-01478-3.
Cardiomyopathy with underlying left ventricular (LV) dysfunction is a heterogenous group of disorders that may be present with, and/or secondary to, coronary artery disease (CAD). The purpose of this review is to demonstrate, via case illustrations, the benefits offered by cardiac positron-emission tomography (PET) stress testing with coronary flow capacity (CFC) in the evaluation and treatment of patients with left ventricular (LV) dysfunction and CAD.
CFC, a metric that is increasing in prominence, represents the integration of several absolute perfusion metrics into clinical strata of CAD severity. Our prior work has demonstrated improvement in regional perfusion metrics as a result of revascularization to territories with severe reduction in CFC. Conversely, when CFC is adequate, there is no change in regional perfusion metrics following revascularization, despite angiographically severe stenosis. Furthermore, Gould et al. demonstrated decreased rates of myocardial infarction and death following revascularization of myocardium with severely reduced CFC, with no clinical benefit observed following revascularization of patients with preserved CFC. In a series of cases, we present pre-revascularization and post-revascularization PET scans with perfusion metrics in patients with LV dysfunction and CAD. In these examples, we demonstrate improvement in LV function and perfusion metrics following revascularization only in cases where baseline CFC is severely reduced. PET with CFC offers unique guidance regarding revascularization in patients with reduced LV function and CAD.
伴有左心室（LV）功能障碍的心肌病是一组异质性疾病，可能存在于冠心病（CAD）之中和/或继发于冠心病。本文通过病例举例，旨在展示心脏正电子发射断层扫描（PET）负荷试验与冠脉血流储备（CFC）在评估和治疗 LV 功能障碍和 CAD 患者方面的优势。
CFC 是一个越来越重要的指标，它将几个绝对灌注指标整合到 CAD 严重程度的临床分层中。我们之前的研究表明，通过血运重建改善严重 CFC 减少的区域灌注指标。相反，当 CFC 充足时，即使存在严重的血管造影狭窄，血运重建后区域灌注指标也不会改变。此外，Gould 等人发现，严重 CFC 减少的心肌血运重建后心肌梗死和死亡率降低，而 CFC 正常的患者血运重建后无临床获益。在一系列病例中，我们呈现了 LV 功能障碍和 CAD 患者血运重建前后的 PET 扫描及其灌注指标。在这些例子中，我们仅在基线 CFC 严重降低的情况下证明了血运重建后 LV 功能和灌注指标的改善。CFC 的 PET 检查为 LV 功能障碍和 CAD 患者的血运重建提供了独特的指导。
