Funktionalität und nichtinvasive Bildgebung

Zusammenfassung

Nichtinvasive Bildgebung spielt eine zentrale Rolle bei Diagnose, Risikostratifizierung und klinischem Management von Patienten mit stabiler koronarer Herzkrankheit (KHK). Die Entscheidung zu einer anatomischen oder funktionellen Bildgebung wird anhand der Patienteneignung, der Prätestwahrscheinlichkeit sowie der lokalen Methodenverfügbarkeit und Expertise getroffen. Aktuelle große Studien zeigen, dass die anatomische Bildgebung zwar die KHK diagnostiziert, aber im Vergleich zur funktionellen Bildgebung keinen signifikanten Mehrwert für die Vorhersage der Gesamtletalität hat. Neben der Funktion der koronaren Makrostrombahn können funktionale Bildgebungsmodalitäten auch die der Mikrostrombahn mit signifikant besserer Vorhersage der Gesamtletalität erfassen. Die Wertigkeit der Ischämietestung ist vor dem Hintergrund der älter werdenden Patienten mit untypischen Symptomen und damit schwieriger Berechnung der Prätestwahrscheinlichkeit als besonders hoch einzustufen. Aktuelle technische Entwicklungen aller Modalitäten erweitern in unterschiedlicher Geschwindigkeit deren Präzision und diagnostische Genauigkeit. Durch eine Vielzahl an randomisierten, kontrollierten Studien wird die klinische Bedeutung der einzelnen Bildgebungsmodalitäten in Bezug auf Kosten, Entscheidungspfade und Letalität der Patienten kontrovers diskutiert.

Abstract

Non invasive imaging plays an important role for the diagnosis, risk stratification and clinical management in patients with stable coronary artery disease (CAD). Decision making for anatomical versus functional imaging strategies is based on individual eligibility, pretest probability, availability of imaging methods and local expertise. Against the background of present randomized controlled trials, it is highlighted that anatomical imaging detects CAD, but has limited value for the prediction of mortality compared to functional testing. Some functional imaging modalities include both, imaging of macro- and microcoronary circulation with relevance for mortality and its improved prediction. The value of functional tests for ischemia becomes significant due to aging patients with unspecific symptoms and insufficient calculation of pretest probability. By now, there is still technical development in every modality to improve precision and accuracy. Recently conducted large, randomized and controlled trials aim to compare functional and anatomical imaging in cost-effectiveness, clinical decision making and prediction of outcome and mortality.

Schlüsselwörter

funktionelle und anatomische Bildgebung - koronare Herzkrankheit - fraktionelle und koronare Flussreserve

Key words

functional and anatomical imaging - coronary artery disease - fractional and coronary flow reserve

• Literatur

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