-
心血管疾病发病率逐年上升,严重威胁着人类健康。除大血管病变外,冠状动脉微血管性疾病(coronary microvascular disease,CMVD)患者也越来越受到广泛关注,其预后不佳,甚至导致心肌梗死、心性死亡,并且因不稳定的心绞痛反复住院治疗、反复行心导管检查,其最终的治疗费用可能会很高[1-4]。因此,对CMVD患者行早期无创性诊断及预后评估,进而采取早期治疗干预以降低心脏不良事件发生率,均具有重要的临床指导意义。CMVD发病的重要原因是冠状动脉微循环功能受损。而冠状动脉血流储备(coronary flow reserve,CFR)是反映冠状动脉功能状态的重要无创性指标。PET/CT定量分析能客观、准确地测量静息和负荷时冠状动脉血流绝对灌注量(myocardial blood flow,MBF),从而获得二者的比值,即CFR,也称之为心肌血流储备(myocardial flow reserve,MFR)。在排除心外膜冠状动脉大血管病变情况下,PET/CT冠状动脉血流储备测定能为CMVD的诊断提供客观依据,可有效评估其预后。
PET/CT冠状动脉血流储备测定在冠状动脉微血管性疾病中的研究进展
Progress in the measurement of coronary reverse flow in coronary microvascular diseaseswith PET/CT
-
摘要: 冠状动脉微血管性疾病(CMVD)是指在多种致病因素下,冠状动脉微血管结构和(或)功能异常所致的劳力性心绞痛或心肌缺血客观证据的临床综合征。CMVD在冠心病中仍有较高的发病率,部分CMVD预后不佳,对其进行早期诊断、预后评估和治疗干预均具有重要的临床意义。PET/CT定量分析能客观、准确地测量静息和负荷状态下冠状动脉血流灌注量,进而获得冠状动脉血流储备,有效地协助早期诊断CMVD,评估其预后和指导治疗。笔者就PET/CT血流储备测定在CMVD中的研究进展进行综述。
-
关键词:
- 正电子发射断层显像计算机体层摄影术 /
- 冠状动脉微血管性疾病 /
- 冠状动脉血流储备
Abstract: Coronary microvascular disease (CMVD) is the clinical syndrome of exertional angina or myocardial ischemia. It is caused by abnormal coronary microvascular structure and/or function that may result from various pathogenic factors. Given the higher incidence of CMVD among patients with coronary heart disease and the poor prognosis of patients with partial CMVD, the early diagnosis, prognostic assessment, and medicaltreatment of CMVDhave critical clinical implications. Quantitative PET/CT analysis can be used toquantify resting and stressed myocardial perfusion values objectively and to obtain coronary flow reserve measurements. Thus, it is an effective approachfor the early diagnosis and prognosis evaluation of CMVD and for guiding therapeutic strategies for this malignancy. In this article, we review the progress in the application of PET/CT blood flow reserve measurement in CMVD. -
[1] Ziadi MC, Dekemp RA, Williams KA, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia[J]. J Am Coll Cardiol, 2011, 58 (7):740-748. DOI:10.1016/j.jacc.2011.01.065. [2] Murthy VL, Naya M, Foster CR, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve[J]. Circulation, 2011, 124 (20):2215-2224. DOI:10.1161/CIRCULA-TIONAHA.111.050427. [3] Taqueti VR, Everett BM, Murthy VL, et al. Interaction of impaired coronary flow reserve and cardiomyocyte injury on adverse cardiovascular outcomes in patients without overt coronary artery disease[J]. Circulation, 2015, 131 (6):528-535. DOI:10.1161/CIRCULATIONAHA.114.009716. [4] Dean J, Cruz SD, Mehta PK, et al. Coronary microvascular dysfunction:sex-specific risk, diagnosis, and therapy[J]. Nat Rev Cardiol, 2015, 12 (7):406-414. DOI:10.1038/nrcardio.2015.72. [5] Pries AR, Reglin B. Coronary microcirculatory pathophysiology:can we afford it to remain a black box?[J]. Eur Heart J, 2017, 38 (7):478-488. DOI:10.1093/eurheartj/ehv760. [6] Cannon RO, Epstein SE. "Microvascular angina" as a cause of chest pain with angiographically normal coronary arteries[J]. Am J Cardiol, 1988, 61 (15):1338-1343. doi: 10.1016/0002-9149(88)91180-0 [7] Crea F, Camici PG, Bairey MCN. Coronary microvascular dysfunction:an update[J]. Eur Heart J, 2014, 35 (17):1101-1111. DOI:10.1093/eurheartj/eht513. [8] Shome JS, Perera D, Plein S, et al. Current perspectives in coronary microvascular dysfunction[J/OL]. Microcirculation, 2017, 24 (1): e12340[2018-01-14]. https://doi.org/10.1111/micc.12340. DOI:10.1111/micc.12340. [9] Löffler AI, Bourque JM. Coronary Microvascular Dysfunction, Microvascular Angina, and Management[J]. Curr Cardiol Rep, 2016, 18 (1):1. DOI:10.1007/s11886-015-0682-9. [10] Saraste A, Kajander S, Han C, et al. PET:Is myocardial flow quantification a clinical reality?[J]. J Nucl Cardiol, 2012, 19 (5):1044-1059. DOI:10.1007/s12350-012-9588-8. [11] Danad I, Uusitalo V, Kero T, et al. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease:cutoff values and diagnostic accuracy of quantitative[(15)O]H2O PET imaging[J]. J Am Coll Cardiol, 2014, 64 (14):1464-1475. DOI:10.1016/j.jacc.2014.05.069. [12] Camici PG, d'Amati G, Rimoldi O. Coronary microvascular dysfunction:mechanisms and functional assessment[J]. Nat Rev Cardiol, 2015, 12 (1):48-62. DOI:10.1038/nrcardio.2014.160. [13] Sciagrà R. Quantitative cardiac positron emission tomography: the time is coming![J/OL]. Scientifica (Cairo), 2012, 2012: e948653[2018-01-14]. http://dx.doi.org/10.6064/2012/948653. DOI:10.6064/2012/948653. [14] 孙茉茉, 李剑明. PET心肌灌注显像及其定量分析的研究进展[J].国际放射医学核医学杂志, 2017, 41 (6):423-429. DOI:10.3760/cma.j.issn.1673-4114.2017.06.008.
Sun MM, LI JM.The research progress of myocardial perfusion and its quantitative analysis with PET[J]. International J Radiat Med Nucl Med, 2017, 41 (6):423-429. DOI:10.3760/cma.j.issn.1673-4114.2017.06.008.[15] Nakazato R, Heo R, Leipsic J, et al. CFR and FFR assessment with PET and CTA:strengths and limitations[J]. Curr Cardiol Rep, 2014, 16 (5):484. DOI:10.1007/s11886-014-0484-5. [16] Al BF, Aljizeeri A, Almasoudi F, et al. Assessment of myocardial blood flow and coronary flow reserve with positron emission tomography in ischemic heart disease:current state and future directions[J]. Heart Fail Rev, 2017, 22 (4):441-453. DOI:10.1007/s10741-017-9625-4. [17] Gould KL, Johnson NP, Bateman TM, et al. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making[J]. J Am Coll Cardiol, 2013, 62 (18):1639-1653. DOI:10.1016/j.jacc.2013. 07.076. [18] von Scholten BJ, Hasbak P, Christensen TE, et al. Cardiac 82Rb PET/CT for fast and non-invasive assessment of microvascular function and structure in asymptomatic patients with type 2 diabetes[J]. Diabetologia, 2016, 59 (2):371-378. DOI:10.1007/s00125-015-3799-x. [19] Marinescu MA, Löffler AI, Ouellette M, et al. Coronary microvascular dysfunction, microvascular angina, and treatment strategies[J]. JACC Cardiovasc Imaging, 2015, 8 (2):210-220. DOI:10.1016/j.jcmg.2014.12.008. [20] Driessen RS, Raijmakers PG, Stuijfzand WJ, et al. Myocardial perfusion imaging with PET[J]. Int J Cardiovasc Imaging, 2017, 33 (7):1021-1031.DOI:10.1007/s10554-017-1084-4. [21] Gulati M, Shaw LJ, Bairey Merz CN, et al. Myocardial ischemia in women:lessons from the NHLBI WISE study[J]. Clin Cardiol, 2012, 35 (3):141-148. DOI:10.1002/clc.21966. [22] Taqueti VR, Shaw LJ, Cook NR, et al. Excess Cardiovascular Risk in Women Relative to Men Referred for Coronary Angiography Is Associated With Severely Impaired Coronary Flow Reserve, Not Obstructive Disease[J]. Circulation, 2017, 135 (6):566-577. DOI:10.1161/CIRCULATIONAHA.116.023266. [23] Marroquin OC, Holubkov R, Edmundowicz D, et al. Heterogeneity of microvascular dysfunction in women with chest pain not attributable to coronary artery disease:implications for clinical practice[J]. Am Heart J, 2003, 145 (4):628-635. DOI:10.1067/mhj.2003.95. [24] Westergren HU, Michaëlsson E, Blomster JI, et al. Determinants of coronary flow reserve in non-diabetic patients with chest pain without myocardial perfusion defects[J/OL]. PLoS One, 2017, 12 (4): e0176511[2018-01-14]. https://doi.org/10.1371/journal.pone.0176511. DOI:10.1371/journal.pone.0176511. [25] Di Carli MF, Janisse J, Grunberger G, et al. Role of chronic hyper-glycemia in the pathogenesis of coronary microvascular dysfunction in diabetes[J]. J Am Coll Cardiol, 2003, 41 (8):1387-1393. DOI:org/10.1016/S0735-1097 (03)00166-9. [26] Murthy VL, Naya M, Foster CR, et al. Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes mellitus[J]. Circulation, 2012, 126 (15):1858-1868. DOI:10.1161/CIRCULATIONAHA.112.120402. [27] Murthy VL, Naya M, Taqueti VR, et al. Effects of sex on coronary microvascular dysfunction and cardiac outcomes[J]. Circulation, 2014, 129 (24):2518-2527. DOI:10.1161/CIRCULATIONAHA.113. 008507. [28] Taqueti VR, Solomon SD, Shah AM, et al. Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction[J]. Eur Heart J, 2018, 39 (10):840-849. DOI:10.1093/eurheartj/ehx721. [29] Naya M, Murthy VL, Taqueti VR, et al. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography[J]. J Nucl Med 2014, 55:248-55. 10.2967/jnumed.113.121442. doi: 10.2967/jnumed.113.121442 [30] Taqueti VR, Hachamovitch R, Murthy VL, et al. Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization[J]. Circulation, 2015, 131 (1):19-27. DOI:10.1161/CIRCULATIONAHA.114.011939. [31] Gupta S, Gupta MM. No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction[J]. Indian Heart J, 2016, 68 (4):539-551. DOI:10.1016/j.ihj.2016.04.006. [32] Brosh D, Assali AR, Mager A, et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality[J]. Am J Cardiol, 2007, 99 (4):442-445. DOI:org/10.1016/j.amjcard.2006.08.054.
计量
- 文章访问数: 3642
- HTML全文浏览量: 2685
- PDF下载量: 11