洲会何作祥-核心脏病学现状与进展a

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1、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www.csnm.com.cnwww.csnc.org.cn2011年北京“五洲”心血管病研讨会ImaginginCoronaryArteryDiseaseChangingrolesCoronarystenosis(coronaryangiography,CTA)?myocardialischemia(SPECT,PET,stressecho)?ChangingstrategyAccuracyofNoninvasiveTestforDiagnosisofCADNo

2、.ofStudiesNo.ofPatientsSensitivitySpecificityExerciseECG147240476877ExercisePerfusionImaging2287518980PharmacologicalStressScintigraphy11<10008591Circulation2000;102:126Guptaetal,1992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,2005AdenRestAdenRestAdenRestCanGatedSPECTimprovesensit

3、ivityforCADdetection?Part0.IntroductiontoNuclearMedicine9ECG-GATEDMYOCARDIALPERFUSIONGatedSPECTvs.CineMRIWangF,etal.EurJNuclMedMolImaging,2009SpecificityofStressTI-201andTc-99mSestamibiSPECTforCADDetectioninWomenStenosis50%(n=51)Stenosis70%(n=64)p=0.002p=0.0004p=0.05N

4、Sp=0.02NSAdaptedfromTailleferetal.JNuclMed1996;37:69P.70.686.394.167.284.492.20102030405060708090100Tl-201Tc-99mSestamibiGatedTc-99mSestamibiSpecificity(%)ExamplesofCoronaryArteryScansNormalConditionModerateCalcificationSevereCalcification0%0%2.7%10.8%48.3%010203040500

5、11-100101-399>400EBTBaselineCalciumScore%with+SPECT(n=17)(n=37)(n=93)(n=89)(n=10)1-10246patientsallasymptomaticexcept34withatypicalCP58+10years75%with2ormoreRFHeet.alCirculation2000;101:244-51EBTCalciumScoreandSPECTThalliumStressTestingClinicalCharacteristics(N=706)ofPat

6、ientswhoUnderwentCTAandSPECT14N(%)/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)Ac

7、curacyofluminalstenosisbycoronaryCTAfordetectingabnormalMPI15StenosisSensitivity*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%22.39954.395.8CTAandSPECT/CTAforDetectio

8、nofHemodynamicallySignificantCoronaryLesionsRisplerJACC2007;49:1059-67050100PercentSensSpecPPVNPVSensSp