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@#With the in-depth study of the pathophysiological changes of ischemic myocardium, some experimental studies have found that in many patients with coronary heart disease, severe lesions and long duration of diseases which do not recover due to revascularization, are mainly related to the viable myocardium in the affected area. Survival myocardium refers to those perfusion defect-induced dysfunctional but not dead cardiomyocytes, including stunned myocardium and hibernating myocardium. Therefore, accurate assessment of viable myocardium is important for the development of clinical treatment options and prognosis assessment of such patients. Positron emission tomography/computed tomography (PET/CT) can evaluate the survival of hibernating myocardium and quantitatively analyze it. Thus PET/CT can provide useful information for the possibility of myocardial function recovery after revascularization, treatment options and prognosis evaluation.
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Objective: To investigate the 18F-FDG PET myocardial scintigraphy and Coronary CT angiography (CTA) combination improve coronary heart disease clinical diagnosis level, and the diagnosis of coronary heart disease treatment technology of standardization for clinical application. Methods:The use of positron radionuclide drug 18F-fluorodeoxyglucose (18F-FDG) was made in 35 patients with myocardial metabolic imaging of coronary arteries and CTA examination, 20 patients with myocardial infarction patients, the FDG PET myocardial scintigraphy and coronary artery CTA combine examination results and confirmed case comparison of results. Results: 18F-FDG PETmyocardial scintigraphy and coronary artery CTA combination in the diagnosis of coronary heart disease, sensitivity and specificity of 100%and 96%. Conclusion: 18F-FDG PET data and coronary artery CTA precision data fusion, the fusion image is accurate, can not only provide clinicians reflect coronary artery anatomy indicators, can also provide reflect myocardial pathological physiology and metabolism index, to verify and supplement each other between the indicators.
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Hypoxia (decreased tissue oxygen tension) is a component of many diseases such as tumors, cerebrovascular diseases and ischemic heart diseases. Although hypoxia can be secondary to a low inspired pO2 or a variety of lung disorders, the most common cause is ischemia due to an oxygen demand greater than the local oxygen supply. In the heart tissue, hypoxia is often observed in persistent low-flow states, such as hibernating myocardium. Direct "hot spot" imaging of myocardial tissue hypoxia is potentially of great clinical importance because it may provide a means of identifying dysfunctional chronically ischemic but viable hibernating myocardium. A series of radiopharmaceuticals that incorporate nitroimidazole moieties have been synthesized to detect decreased local tissue pO2. In contrast to agents that localize in proportion to perfusion, these agents concentrate in hypoxic tissue. However, the ideal agents are not developed yet and the progress is very slow. Furthermore, the research focus is on tumor hypoxia nowadays. This review introduces the myocardial hypoxia imaging with summarizing the development of radiopharmaceuticals.
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Hipoxia , Corazón , Isquemia , Pulmón , Isquemia Miocárdica , Miocardio , Oxígeno , Perfusión , RadiofármacosRESUMEN
BACKGROUND: Reversibly dysfunctional myocardium caused by chronic reduction of coronary perfusion was named as hibernating myocardium. The clinical characteristics, however, was not well studied. METHOD: To observed the effects of revascularization on regional wall motion(RWM) abnormalities in patients with chronic ischemic heart disease, letf ventriculogram and dipyridamole stress Tl reinjection scan with reinjection imagine were done in 60 patients with angina or old myocardial infarction before and after PTCA. Subjects were divided into two groups, group A(21 patients, improved RWM after PTCA) and group B(39 patients, no change or aggravated RWM after PTCA). RESULTS: There were no significant differences in age and sex distribution between two group. Single vessel disease was more prevalent in group A (7/21, 33.3%) than in group B(1/39, 2.6%, p<0.05), and old myocardial infarction was more prevalent in group B(24/39, 61.5%) compared to group A(7/21, 33.3%, p<0.05). Reversible perfusion defects on Tl scan were found in 19 patients, 15 of whom(78.9%) showed improved RWM after PTCA. CONCLUSION: Hibernating myocardium was more prevalent in single vessel disease and angina patients. Sensitivity of Tl reinjection scan for detection of viable myocardium was 78.9%.
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Humanos , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Dipiridamol , Hibernación , Infarto del Miocardio , Isquemia Miocárdica , Miocardio , Perfusión , Distribución por SexoRESUMEN
Objective To observe the characteristics of coronary hemodynamics in acute hibernating myocardium (AHM) model by intracoronary doppler guidewire. Methods 13 little domestic Chinese swine were established to the model of AHM by interventional method (closed chest),intracoronary Doppler guidewire were used to measure average peak velocity (APV),diastolic systolic velocity ratio (DSVR) and coronary flow velocity reserve (CFVR) distal to the stenosis in the period of pre model,post model and reperfusion.Then animals were executed,the histomography changes of AHM cells were observed.Results 10 animals (76 92%) were established to the model of AHM successfully,myocardium necrosis were not found under microscopical examination.APV and CFVR distal to the stenosis decreased significantly in AHM model ( P
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We set up an animal model of acute hibernating myocardium isolated rat heart. which were perfused with human red blood cell-enhanced modified K-H buffer,were used. During ischemia,coronary flow were reduced to 20%. The results show: At 30 minutes of ischemia,left ventircular peak systolic pressure,+dp/dt max and - dp/dt max were decreased to 44% ,33% and 26% (P