五洲会何作祥核心脏病学现状与进展a课件

五洲会何作祥核心脏病学现状与进展a课件现在是1页\一共有31页\编辑于星期三AccuracyofNoninvasiveTestforDiagnosisofCADNo.ofStudiesNo.ofPatientsSensitivitySpecificityExerciseECG147240476877ExercisePerfusionImaging2287518980PharmacologicalStressScintigraphy11<10008591Circulation2000;102:126现在是2页\一共有31页\编辑于星期三现在是3页\一共有31页\编辑于星期三Guptaetal,1992现在是4页\一共有31页\编辑于星期三腺苷负荷试验心肌灌注显像多中心临床试验田月琴,等,中华心血管病杂志,2005现在是5页\一共有31页\编辑于星期三AdenRestAdenRestAdenRest现在是6页\一共有31页\编辑于星期三CanGatedSPECTimprovesensitivityforCADdetection?现在是7页\一共有31页\编辑于星期三Part0.IntroductiontoNuclearMedicine8ECG-GATEDMYOCARDIALPERFUSION现在是8页\一共有31页\编辑于星期三GatedSPECTvs.CineMRIWangF,etal.EurJNuclMedMolImaging,2009现在是9页\一共有31页\编辑于星期三SpecificityofStressTI-201andTc-99mSestamibi

SPECTforCADDetectioninWomenStenosis50%(n=51)Stenosis70%(n=64)p=0.002p=0.0004p=0.05NSp=0.02NSAdaptedfromTailleferetal.JNuclMed1996;37:69P.70.686.394.167.284.492.20102030405060708090100Tl-201Tc-99m

SestamibiGatedTc-99m

SestamibiSpecificity(%)现在是10页\一共有31页\编辑于星期三ExamplesofCoronaryArteryScansNormalConditionModerateCalcificationSevereCalcification现在是11页\一共有31页\编辑于星期三0%0%2.7%10.8%48.3%01020304050011-100101-399>400EBTBaselineCalciumScore%with+SPECT(n=17)(n=37)(n=93)(n=89)(n=10)1-10246patientsallasymptomaticexcept34withatypicalCP58+10years75%with2ormoreRFHeet.alCirculation2000;101:244-51EBTCalciumScoreandSPECTThalliumStressTesting现在是12页\一共有31页\编辑于星期三ClinicalCharacteristics(N=706)ofPatientswhoUnderwentCTAandSPECT13N(%)/averageAge56.1±9.9Male450(63.7%)BodyMassIndex25.1*Diabetes102(14.4)Hypertension388(55.0)Hyperlipidemia407(57.6)Smoking273(38.7)FamilyHistoryofCAD165(23.4)SymptomsAsymptomatic118(16.7)Atypicalchestpain476(67.4)Typicalchestpain112(15.9)现在是13页\一共有31页\编辑于星期三AccuracyofluminalstenosisbycoronaryCTAfordetectingabnormalMPI14StenosisSensitivity*Specificity*PPV*NPV**Patients’Level≥50%80.256.721.595.1≥75%48.490.442.792.2≥90%29.798.47390.4VascularLevel≥50%69.679.315.897.9≥75%40.295.633.696.6≥90%22.39954.395.8现在是14页\一共有31页\编辑于星期三CTAandSPECT/CTAforDetectionofHemodynamicallySignificantCoronaryLesionsRisplerJACC2007;49:1059-67050100PercentSensSpecPPVNPVSensSpecPPVNPVCTASPECT/CTA9696999963953177现在是15页\一共有31页\编辑于星期三PET/CTinCADNamdarM,etal.JNM2005现在是16页\一共有31页\编辑于星期三MyocardialInfarctionsarecaused

byLow-GradeStenosesPooleddatafrom4studies:Ambroseetal,1988;Littleetal,1988;Nobuyoshietal,1991;andGiroudetal,1992.

(AdaptedfromFalketal.)现在是17页\一共有31页\编辑于星期三RiskStratificationLow

<1%peryearIntermediate

1-3%peryearHigh

>3%peryearAdaptedfromGibbonsRJ,etal.JAmCollCardiol.1999;33:2092-2197.RiskofCardiacDeath:现在是18页\一共有31页\编辑于星期三RiskStratification:

NoninvasiveTestingMarkersAmountofinfarctedmyocardiumAmountofjeopardizedmyocardiumDegreeofjeopardy现在是19页\一共有31页\编辑于星期三RiskStratification:

NoninvasiveTestingMarkersLeftventricularsystolicfunction现在是20页\一共有31页\编辑于星期三PredictorsofcardiacmortalityfactorsestimatingtheextentofLVdysfunctionLVEFtheextentofinfarctedmyocardiumtransientischemicdilationoftheLVandincreasedlunguptake现在是21页\一共有31页\编辑于星期三Predictorsofthesubsequent

developmentofacute

ischemicsyndromesmarkersofprovocativeischemiaexertionalsymptoms,electrocardiographicchangestheextentofreversibleperfusiondefectsstress-inducedventriculardyssynergy现在是22页\一共有31页\编辑于星期三现在是23页\一共有31页\编辑于星期三Follow-upTime(Months)9080706050403020100CumulativeEvent-FreeSurvival.7.6.5NormalCoronariesAngiographicCADp=nsYangMF,NMC,2006现在是24页\一共有31页\编辑于星期三Prognosticvalue:

Perfusionimagingvs.AngiographyPatientswithanormalstressmyocardialperfusionimagingareatlowriskforcardiacevents(<1%mortalityperyear),eveninthepresenceofangiographicallysignificantcoronaryarterystenosis.现在是25页\一共有31页\编辑于星期三

2.9

0.3

0.8

2.3

0.5

2.7

2.9

4.2

0.0

1.0

2.0

3.0

4.0

5.0

EventRate/Year,%

CardiacDeath

MI

HachamovitchR,etal.Circulation.1998;97:535-543.ScanResult****MildlyAbnormalModeratelyAbnormalSeverelyAbnormalNormal2946884455898Prognosis:MPIScan

SeverityPredictsOutcome*P<.001**P<.01nSSS<44-89-13>13现在是26页\一共有31页\编辑于星期三CardiacDeathRate(%/y)HachamovitchR,etal.Circulation1998现在是27页\一共有31页\编辑于星期三EnrollmentandOutcomes3,071Patientsmetprotocoleligibilitycriteria2,287ConsentedtoParticipate(74%ofprotocol-eligiblepatients)1,149WereassignedtoPCIgroup46DidnotundergoPCI27Hadalesionthatcouldnotbedilated1,006Receivedatleastonestent784Didnotprovideconsent-450DidnotreceiveMDapproval-237Declinedtogivepermission-97Hadanunknownreason107Werelosttofollow-up1,149Wereincludedintheprimaryanalysis1,138Wereassignedtomedical-therapygroup97Werelosttofollow-up1,138Wereincludedintheprimaryanalysis现在是28页\一共有31页\编辑于星期三Shaw,L.J.etal.Circulation2008;117:1283-1291Kaplan-Meiersurvivalforpatientsbyresidu