靜息SPECT心肌灌注

+PET心肌代謝顯像評價心肌存活孫曉昕MyocardialViabilitySevereWallMotionImpairmentIrreversiblePotentiallyReversible ifbloodflowrestoredMyocardialHibernationMyocardialStunningLVEF37%LVEDV128mlLVEF76%LVEDV104ml8monthsafterLADgraftReversibleWallMotionImpairmentandResponsetoRevascularizationafterRahimtoola血運重建術

對左心功能衰竭患者的影響如果梗死部位有一定數量的存活心肌改善局部和/或左心整體功能阻止心臟的擴大和左室重構改善心衰癥狀提高運動耐受性改善患者近期及長期預后如果無存活心肌，術后心功能改善的可能性小，而且手術的死亡率隨射血分數的減低而增加(<35%,約8%,>50%,約2%)。冠狀動脈微循環（尸檢）冠狀動脈造影SPECT心肌灌注-PET心肌代謝

心肌存活心肌梗死正常不匹配匹配臨床應用冠心病，心肌梗死后，冬眠心肌的評價冠脈起源異常，心肌血流灌注受損情況及冬眠心肌的評價秦**，男，55歲。間斷胸悶、氣短1月余，加重伴反復暈厥2天。入院診斷：CAD，AMI(非ST抬高)，OMI（下壁），PCI術后，室速，室顫，CPR術后2018-8-8進行靜息灌注+PET-CT心肌代謝顯像。

Revascularization

inSevereLeftVentricularDysfunction:DoesMyocardial

Viability

EvenMatter?

Annualmortalityrateinpatientswithandwithoutmyocardialviabilitytreatedwithrevascularizationvsmedicaltherapy(Meta-analysisbyAllmanetal).ClinMedInsightsCardiol.

2015Jun28;9(Suppl1):105-9.QuantitativeRelationBetweenMyocardialViabilityandImprovementinHeartFailureSymptomsAfterRevascularizationinPatientsWithIschemicCardiomyopathy(1)Circulation.

1995Dec15;92(12):3436-44.13Nammoniaand18F-FDGPETScatterplotshowingtherelationbetweentheflow–metabolismmismatches,andthechangeinfunctionalstatusgrade(SpecificActivityScale)afterCABG,expressedaspercentimprovementfrombaseline.Therelationwasy=24.27+2.04x,

r=.87,SEE=10.8,

P<.001.Thisoperatingpointwasassociatedwithasensitivityof76%andaspecificityof78%forpredictinganimprovementinfunctionalclassofatleastone.ScatterplotofchangesinMETSofactivityafterCABG(Follow-up)groupedbyanatomicextentofbloodflow–metabolismmismatch(ie,groupA,<5%;groupB,5–17%;andgroupC,≥18%).Pre-opindicatespreoperative.QuantitativeRelationBetweenMyocardialViabilityandImprovementinHeartFailureSymptomsAfterRevascularizationinPatientsWithIschemicCardiomyopathy(2)臨床應用冠心病，心肌梗死后，冬眠心肌的評價冠脈起源異常，心肌血流灌注受損情況及冬眠心肌的評價F,16m,左冠起源于肺動脈，右冠→側支→左冠→肺動脈M,9m,左冠脈起源于肺動脈，左冠→肺動脈M,8m