心肌存活与缺血性心肌病

静息SPECT心肌灌注

+PET心肌代谢显像评价心肌存活孙晓昕1心肌存活与缺血性心肌病5/8/20242心肌存活与缺血性心肌病5/8/20243心肌存活与缺血性心肌病5/8/20244心肌存活与缺血性心肌病5/8/2024MyocardialViabilitySevereWallMotionImpairmentIrreversiblePotentiallyReversible ifbloodflowrestoredMyocardialHibernationMyocardialStunning5心肌存活与缺血性心肌病5/8/2024LVEF37%LVEDV128mlLVEF76%LVEDV104ml8monthsafterLADgraftReversibleWallMotionImpairmentandResponsetoRevascularizationafterRahimtoola6心肌存活与缺血性心肌病5/8/2024血运重建术

对左心功能衰竭患者的影响如果梗死部位有一定数量的存活心肌改善局部和/或左心整体功能阻止心脏的扩大和左室重构改善心衰症状提高运动耐受性改善患者近期及长期预后如果无存活心肌，术后心功能改善的可能性小，而且手术的死亡率随射血分数的减低而增加(<35%,约8%,>50%,约2%)。7心肌存活与缺血性心肌病5/8/2024冠状动脉微循环（尸检）冠状动脉造影8心肌存活与缺血性心肌病5/8/2024SPECT心肌灌注-PET心肌代谢

心肌存活心肌梗死正常不匹配匹配9心肌存活与缺血性心肌病5/8/2024临床应用冠心病，心肌梗死后，冬眠心肌的评价冠脉起源异常，心肌血流灌注受损情况及冬眠心肌的评价10心肌存活与缺血性心肌病5/8/2024秦**，男，55岁。间断胸闷、气短1月余，加重伴反复晕厥2天。入院诊断：CAD，AMI(非ST抬高)，OMI（下壁），PCI术后，室速，室颤，CPR术后2018-8-8进行静息灌注+PET-CT心肌代谢显像。11心肌存活与缺血性心肌病5/8/202412心肌存活与缺血性心肌病5/8/202413心肌存活与缺血性心肌病5/8/202414心肌存活与缺血性心肌病5/8/2024

Revascularization

inSevereLeftVentricularDysfunction:DoesMyocardial

Viability

EvenMatter?

Annualmortalityrateinpatientswithandwithoutmyocardialviabilitytreatedwithrevascularizationvsmedicaltherapy(Meta-analysisbyAllmanetal).ClinMedInsightsCardiol.

2015Jun28;9(Suppl1):105-9.15心肌存活与缺血性心肌病5/8/2024QuantitativeRelationBetweenMyocardialViabilityandImprovementinHeartFailureSymptomsAfterRevascularizationinPatientsWithIschemicCardiomyopathy(1)Circulation.

1995Dec15;92(12):3436-44.13Nammoniaand18F-FDGPETScatterplotshowingtherelationbetweentheflow–metabolismmismatches,andthechangeinfunctionalstatusgrade(SpecificActivityScale)afterCABG,expressedaspercentimprovementfrombaseline.Therelationwasy=24.27+2.04x,

r=.87,SEE=10.8,

P<.001.Thisoperatingpointwasassociatedwithasensitivityof76%andaspecificityof78%forpredictinganimprovementinfunctionalclassofatleastone.16心肌存活与缺血性心肌病5/8/2024ScatterplotofchangesinMETSofactivityafterCABG(Follow-up)groupedbyanatomicextentofbloodflow–metabolismmismatch(ie,groupA,<5%;groupB,5–17%;andgroupC,≥18%).Pre-opindicatespreoperative.QuantitativeRelationBetweenMyocardialViabilityandImprovementinHeartFailureSymptomsAfterRevascularizationinPatientsWithIschemicCardiomyopathy(2)17心肌存活与缺血性心肌病5/8/2024临床应用冠心病，心肌梗死后，冬眠心肌的评价冠脉起源异常，心肌血流灌注受损情况及冬眠心肌的评价18心肌存活与缺血性心肌病5/8/2024F,16m,左冠起源于肺动脉，右冠→侧支→左冠→肺动脉19心肌存活与缺血性心肌病5/8/202420心肌存活与缺血性心肌病5/8/202421心肌存活与缺血性心肌病5/8/2024M,9m,左冠脉起源于肺动脉，左冠→肺动脉22心肌存活与缺血性心肌病5/8/202423心肌存活与缺血性心肌病5/8/202424心肌存活与缺血性心肌病5/8/2024M,8m，左冠起源于肺动脉，左冠→肺动脉25心肌存活与缺血性心肌病5/8/202426心肌存活与缺血性心肌病5/8/202427心肌存活与缺血性心肌病5/8/