Frühdiagnostik und Risikostratifizierung der koronaren Herzerkrankung bei mittlerer Vortestwahrscheinlichkeit durch „gated“ SPECT
Tóm tắt
Die frühzeitige und kosteneffektive Diagnostik sowie die prognostische Beurteilung der koronaren Herzkrankheit (KHK) bilden die Grundlagen einer risikostratifizierten Therapie zur Senkung von Morbidität und Mortalität. Die EKG-getriggerte Myokard-SPECT („gated“ SPECT) diagnostiziert durch Erfassung von myokardialer Perfusion und linksventrikulärer Funktion eine hämodynamisch relevante KHK mit hoher Sensitivität und Spezifität, gestattet eine Quantifizierung des Schweregrades und der Ausdehnung einer Myokardischämie und ermöglicht darüber hinaus eine zuverlässige Abschätzung der zukünftigen kardialen Ereignisrate unabhängig von anderen klinischen und diagnostischen Parametern. Ein diagnostischer Zugewinn der „gated“ SPECT als „gatekeeper“ vor invasiven diagnostischen Prozeduren ergibt sich insbesondere bei Patienten mit mittleren Vortestwahrscheinlichkeiten und bei asymptomatischen Hochrisikopatienten. Neuere Untersuchungen belegen, dass der „gated“ SPECT eine herausragende Rolle v. a. bei der Erkennung und Beurteilung einer KHK bei Frauen und Patienten mit Diabetes mellitus zuzuschreiben ist.
Tài liệu tham khảo
Abidov A, Bax JJ, Hayes SW et al (2003) Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT. J Am Coll Cardiol 42:1818–1825
Bateman TM (1997) Clinical relevance of a normal myocardial perfusion scintigraphic study. J Nucl Cardiol 4:172–173
Berman DS, Kang X, Hayes SW et al (2003) Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management. J Am Coll Cardiol 41:1125–1133
De Lorenzo A, Lima RS, Siqueira-Filho AG, Pantoja MR (2002) Prevalence and prognostic value of perfusion defects detected by stress technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease. Am J Cardiol 90:827–832
DePuey EG, Rozanski A (1995) Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact. J Nucl Med 36:952–955
Dissmann W, deRidder M (2002) The soft science of German cardiology. Lancet 359:2027–2029
Gill JB, Ruddy TD, Newell JB, Finkelstein DM, Strauss HW, Boucher CA (1987) Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 317:1485–1489
Giri S, Shaw LJ, Murthy DR et al (2002) Impact of diabetes on the risk stratification using stress singlephoton emission computed tomography myocardial perfusion imaging in patients with symptoms suggestive of coronary artery disease. Circulation 105:32–40
Hachamovitch R, Berman DS, Kiat H et al (1996) Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 93:905–914
Hachamovitch R, Berman DS, Kiat H et al (1996) Effective risk stratification using exercise myocardial perfusion SPECT in women: gender-related differences in prognostic nuclear testing. J Am Coll Cardiol 28:34–44
Hachamovitch R, Berman DS, Shaw LJ et al (1998) Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 97:535–543
Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 107:2900–2906
Hendel RC, Corbett JR, Cullom SJ, DePuey EG, Garcia EV, Bateman TM (2002) The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine. J Nucl Cardiol 9:135–143
Iskander S, Iskandrian AE (1998) Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging. J Am Coll Cardiol 32:57–62
Jacobs AK (2003) Coronary revascularization in women in 2003: sex revisited. Circulation 107:375–377
Kahn R et al (1998) Consensus development conference on the diagnosis of coronary heart disease in people with diabetes: 10–11 February 1998, Miami, Florida. American Diabetes Association. Diabetes Care 21:1551–1559
Kang X, Berman DS, Lewin HC et al (1999) Incremental prognostic value of myocardial perfusion single photon emission computed tomography in patients with diabetes mellitus. Am Heart J 138:1025–1032
Lansky AJ (2004) Outcomes of percutaneous and surgical revascularization in women. Prog Cardiovasc Dis 46:305–319
Lima RSL, Watson DD, Goode AR et al (2003) Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. J Am Coll Cardiol 42:64–70
McClellan JR, Travin MI, Herman SD et al (1997) Prognostic importance of scintigraphic left ventricular cavity dilation during intravenous dipyridamole technetium-99m sestamibi myocardial tomographic imaging in predicting coronary events. Am J Cardiol 79:600–605
Merz NB, Johnson BD, Kelsey PSF et al (2001) Diagnostic, prognostic, and cost assessment of coronary artery disease in women. Am J Manag Care 7:959–965
Mieres JH, Shaw LJ, Arai A et al (2005) Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 111:682–696
Mieres JH, Makaryus AN, Redberg RF, Shaw LJ (2007) Noninvasive cardiac imaging. Am Fam Physician 75:1219–1228
Nowak B (2004) Contributions of nuclear cardiology to prognosis and risk stratification in coronary artery disease. Nuklearmediziner 27:176–185
Rajagopalan N, Miller TD, Hodge DO, Frye RL, Gibbons RJ (2005) Identifying high-risk asymptomatic diabetic patients who are candidates for screening stress single-photon emission computed tomography imaging. J Am Coll Cardiol 45:43–49
Santana-Boado C, Candell-Riera J, Castell-Conesa J et al (1998) Diagnostic accuracy of technetium-99m-MIBI myocardial SPECT in women and men. J Nucl Med 39:751–755
Schaefer WM, Lipke CS, Standke D et al (2005) Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: MRI validation and comparison of the Emory Cardiac Tool Box with QGS and 4D-MSPECT. J Nucl Med 46:1256–1263
Schäfers M (2002) Methoden und klinische Anwendung der Nuklearkardiologie: Positionsbericht. Nuklearmedizin 41:3–13
Sharir T, Germano G, Kavanagh PB et al (1999) Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation 100:1035–1042
Shaw LJ, Hachamovitch R, Berman DS et al (1999) The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol 33:661–669
Shaw LJ, Hendel R, Borges-Neto S et al; Myoview Multicenter Registry (2003) Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4728 patients. J Nucl Med 44:134–139
Shaw LJ, Iskandrian AE (2004) Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 11:171–185
Taillefer R, DePuey EG, Udelson JE, Beller GA, Latour Y, Reeves F (1997) Comparative diagnostic accuracy of Tl-201 and Tc-99m sestamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 29:69–77
Travin MI, Heller GV, Johnson LL et al (2004) The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99m sestamibi myocardial perfusion imaging. J Nucl Cardiol 11:253–262
Underwood SR, Godman B, Salyani S, Ogle JR, Ell PJ (1999) Economics of myocardial perfusion imaging in Europe – the EMPIRE Study. Eur Heart J 20:157–166
Vanzetto G, Ormezzano O, Fagret D, Comet M, Denis B, Machecourt J (1999) Long-term additive prognostic value of thallium-201 myocardial perfusion imaging over clinical and exercise stress test in low to intermediate risk patients: study in 1137 patients with 6-year follow-up. Circulation 100:1521–1527
Wackers FJ, Young LH, Inzucchi SE et al; Detection of Ischemia in Asymptomatic Diabetics Investigators (2004) Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 27:1954–1961
Wenger NK (2003) Coronary heart disease: the female heart is vulnerable. Prog Cardiovasc Dis 46:199–229
Zellweger MJ, Hachamovitch R, Kang X et al (2004) Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients. Eur Heart J 25:543–550