1、侯玉清南方医科大学南方医院,存活心肌检测及CTO介入治疗,血管再通成功率 再狭窄率 再闭塞率 能否改善预后有无存活心肌,CTO介入治疗关注焦点,1.冬眠心肌2.顿抑心肌3.坏死心肌4.瘢 痕 冬眠、顿抑心肌均属存活心肌， 坏死心肌和瘢痕属于不可逆性心肌损害,存活心肌（Myocardial Viability）,存活心肌检测方法,1.心肌灌注显像(99mTc-MIBI)：多巴酚丁胺负荷201铊(201Tl)：运动再分布再灌注201Tl心肌显像: 2.超声心动图显像多巴酚丁胺负荷超声心动图 3.对比增强磁共振 4.18FDG-PET 5.其它：CT灌注显像等。PET灌注及代谢显像金标准！,Nega
2、tive stress echo before PCI,Apical 4 chamber view at rest,Apical 4 chamber view at peak stress,Positive stress echo before PCI,Apical 4 chamber view at rest,Apical 4 chamber view at peak stress,Positive stress echo before PCI,Apical 2 chamber view at rest,Apical 2 chamber view at peak stress,CASE:LA
3、D-CTO,心肌代谢显像及心肌存活性评估,显像剂： 18F-FDG或11C-软脂酸方 法： 血流+代谢 诊断依据：,南方PET中心,1.正常显像（正常心肌）正常灌注 正常FDG代谢 2.不匹配显像（存活心肌）灌注减少 FDG正常代谢 3.匹配显像（坏死心肌）灌注缺损 代谢缺损,Normal Study:,Left Ventricle of myocardium. The myocardial wall is represented as a ring. This image shows normal blood flow and normal metabolic activity. Thus,
4、 this is a normally functioning myocardium.,Mismatched Study:,This image shows a decrease in blood flow and an increase in metabolism.,This image shows a decrease in both blood flow and metabolism.,Matched Study:,PET血流及代谢显像未见异常,冠心病，心梗，心肌存活,南方PET中心,血流显像,代谢显像,冠心病，前壁心梗，无存活心肌,南方PET中心,血流显像,代谢显像,存活心肌检测意义,1.左室功能（EF）是MI后长期预后的重要预测因素； 2.冠脉严重狭窄/闭塞及EF低下者MACE事件及病死率较高： 3.有存活心肌(冬眠及顿抑心肌17%)者通过血运重建可以改善左室功能并改变预后， 4 持续严重缺血则导致心肌凋亡、坏死、纤维化，最终导致心功能衰竭。,J Nucl Med Technol 1999;27:93-102,CTO治疗的合理方式: 临床病情 存活心肌 病变特征 术者经验决定,存活心肌检测及CTO介入治疗,总 结,Thank you!,
