文档介绍：核心脏病学现状与进展
何作祥
国家心血管病中心
中国医学科学院阜外心血管病医院
2011年北京“五洲”心血管病研讨会
Imaging in Coronary Ar)
Symptoms
Asymptomatic
118 ()
Atypical chest pain
476 ()
Typical chest pain
112 ()
Accuracy of luminal stenosis by coronary CTA for detecting abnormal MPI
*
Stenosis
Sensitivity*
Specificity*
PPV*
NPV**
Patients’ Level
≥50%
≥75%
≥90%
73
Vascular Level
≥50%
≥75%
≥90%
99
CTA and SPECT/ CTA for Detection of Hemodynamically Significant Coronary Lesions
Rispler JACC 2007; 49: 1059-67
0
50
100
Percent
Sens Spec PPV NPV
Sens Spec PPV NPV
CTA
SPECT/ CTA
96
96
99
99
63
95
31
77
PET/CT in CAD
Namdar M, et al. JNM 2005
Myocardial Infarctions are caused by Low-Grade Stenoses
Pooled data from 4 studies: Ambrose et al, 1988; Little et al, 1988; Nobuyoshi et al, 1991; and Giroud et al, 1992. (Adapted from Falk et al.)
Risk Stratification
Low
<1% per year
Intermediate
1-3% per year
High
>3% per year
Adapted from Gibbons RJ, et al. J Am Coll Cardiol. 1999;33:2092-2197.
Risk of Cardiac Death:
Risk Stratification: Noninvasive Testing Markers
Amount of infarcted myocardium
Amount of jeopardized myocardium
Degree of jeopardy
Risk Stratification: Noninvasive Testing Markers
Left ventricular systolic function
Predictors of cardiac mortality
factors estimating the extent of LV dysfunction
LVEF
the extent of infarcted myocardium
transient ischemic dilation of the LV
and increased lung uptake
Predictors of the subsequent development of acute ischemic syndromes
markers of provocative ischemia
exertional symptoms,
electrocardiographic changes
the extent of reversible perfusion defects
stress-induced ventricular dyssynergy
Follow-up Time (Months)
90
80
70
60
50
40
30
20
10
0
C