Download PDF
Der Nuklearmediziner 2020; 43(01): 20-27
DOI: 10.1055/a-1062-1101
Nuklearkardiologie
© Georg Thieme Verlag KG Stuttgart · New York

Koronare Herzkrankheit: Aktueller Stand der klinischen Anwendung der Myokardperfusionsszintigrafie im Rahmen des chronischen Koronarsyndroms

Coronary artery disease: Current state and clinical use of myocardial perfusion scintigraphy in the context of chronic coronary syndrome
Christian Goetz
1   Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
,
Philipp T. Meyer
1   Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
,
Constantin von zur Mühlen
2   Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg Bad Krozingen, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2020 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Myokardperfusionsszintigrafie (MPS) hat sich im Bereich der klinischen Anwendung und Methodik in Deutschland in den 10 letzten Jahren kontinuierlich entwickelt. Die neue europäische Leitlinie zur Diagnostik und Behandlung des neu definierten chronischen Koronarsyndroms hat die Rolle der nicht invasiven Bildgebung und damit der nuklearmedizinischen Verfahren bestätigt und gestärkt. Die MPS liefert wertvolle Beiträge zur klinischen Prognoseeinschätzung und Therapieentscheidung aufgrund des Zusammenhanges von szintigrafisch nachgewiesener Perfusionsstörung mit der Häufigkeit von kardiovaskulärem Tod und nicht tödlichem Herzinfarkt.

In diesem Artikel wird ein Überblick über die Einsatzbereiche, die aktuellen Leitlinien und den momentanen Stellenwert der MPS sowie eine kurze Zusammenfassung der praktischen Anwendung des Verfahrens gegeben.

Abstract

Myocardial perfusion scintigraphy (MPS) has been continuously developing in the field of clinical applications and methodology in Germany within the last 10 years. The new European guidelines for the diagnosis and treatment of the newly defined chronic coronary syndrome has confirmed and strengthened the role of non-invasive imaging and thus of nuclear medicine procedures.

MPS provides valuable contributions to the clinical prognosis assessment and treatment decision due to the established relationship between proven regional ischemia and the incidence of cardiovascular death and non-fatal myocardial infarction.

Tis article gives an overview of the application fields, of the current guidelines and of the current clinical status of the MPS, as well as a brief summary of the practical application of the procedure.

Schlüsselwörter

Nuklearkardiologie - Myokard-Perfusions-Szintigrafie - koronare Herzkrankheit

Keywords

nuclear cardiology - myocardial perfusion scintigraphy - coronary heart
 

  • Literatur

  • 1 Fox KAA, Metra M, Morais J. et al. The myth of ‘stable’ coronary artery disease. Nat Rev Cardiol 2019; DOI: 10.1038/s41569-019-0233-y. [im Druck]
    CrossrefPubMedGoogle Scholar
  • 2 Knuuti J, Wijns W, Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2019; DOI: 10.1093/eurheartj/ehz425. [im Druck]
    CrossrefPubMedGoogle Scholar
  • 3 Montalescot G, Sechtem U, Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34: 2949-3003
    CrossrefPubMedGoogle Scholar
  • 4 Lindner O, Bengel F, Burchert W. et al. Myokard-Perfusions-SPECT (DGN Handlungsempfehlung (S1-Leitlinie)). 2017 (AWMF Registernummer 031-006)
    PubMedGoogle Scholar
  • 5 Bundesärztekammer. Kassenärztliche Bundesvereinigung. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Nationale Versorgungs-Leitlinie Chronische KHK (Langfassung), 5. Auflage 2019 Version 1 (AWMF-Register-Nr.: nvl-004).
    PubMedGoogle Scholar
  • 6 Lindner O, Bauersachs J, Bengel F. et al. Positionspapier Nuklearkardiologie - Update 2018. Aktueller Stand der klinischen Anwendung. Nuklearmedizin 2018; 57: 146-152
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Greenwood JP, Ripley DP, Berry C. et al. Effect of care guided by cardiovascularmagnetic resonance, myocardial perfusion scintigraphy, or NICE guidelines on subsequent unnecessary angiography rates: the CE-MARC 2 randomized clinical trial. JAMA 2016; 316: 1051-1060
    CrossrefPubMedGoogle Scholar
  • 8 Knuuti J, Ballo H, Juarez-Orozco LE. et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J 2018; 39: 3322-3330
    CrossrefPubMedGoogle Scholar
  • 9 Lindner O, Burchert W, Schäfer WM. et al. Myocardial Perfusion SPECT 2018 in Germany: Results of the 8th Survey. Nuklearmedizin 2019; 58: 425-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Hachamovitch R, Hayes SW, Friedman JD. et al. Comparison of the short-term survivalbenefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003; 107: 2900-2907
    CrossrefPubMedGoogle Scholar
  • 11 Shaw LJ, Berman DS, Maron DJ. et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 2008; 117: 1283-1291
    CrossrefPubMedGoogle Scholar
  • 12 Windecker S, Kolh P, Alfonso F. et al. 2014 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2014; 35: 2541-2619
    CrossrefPubMedGoogle Scholar
  • 13 Schinkel AF, Bax JJ, Poldermans D. et al. Hibernating myocardium: diagnosis and patient outcomes. Curr Probl Cardiol 2007; 32: 375-410
    CrossrefPubMedGoogle Scholar
  • 14 Bonow RO, Maurer G, Lee KL. et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med 2011; 364: 1617-1625
    CrossrefPubMedGoogle Scholar
  • 15 McMurray JJ, Adamopoulos S, Anker SD. et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur J Heart Fail 2012; 14: 803-869
    CrossrefPubMedGoogle Scholar
  • 16 Carson P, Wertheimer J, Miller A. et al. Surgical Treatment for Ischemic Heart Failure (STICH) Trial: Mode of Death Results. JACC Heart Fail 2013; 1: 400-408
    CrossrefPubMedGoogle Scholar
  • 17 Bax JJ, Delgado V. Myocardial viability as integral part of the diagnostic and therapeutic approach to ischemic heart failure. J Nucl Cardiol 2015; 22: 229-245
    CrossrefPubMedGoogle Scholar
  • 18 Van Dongen AJ, van Rijk PP. Minimizing liver, bowel, and gastric activity in myocardial perfusion SPECT. J Nucl Med 2000; 41: 1315-1317
    PubMedGoogle Scholar
  • 19 Verberne HJ, Acampa W, Anagnostopoulos C. et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015; 42: 1929-1940
    CrossrefPubMedGoogle Scholar
  • 20 Zoghbi GJ, Dorfman TA, Iskandrian AE. The effects of medications on myocardial perfusion. J Am Coll Cardiol 2008; 52: 401-416
    CrossrefPubMedGoogle Scholar
  • 21 Yoon AJ, Melduni RM, Duncan SA. et al. The effect of beta-blockers on the diagnostic accuracy of vasodilator pharmacologic SPECT myocardial perfusion imaging. J Nucl Cardiol 2009; 16: 358-367
    CrossrefPubMedGoogle Scholar
  • 22 Reyes E, Stirrup J, Roughton M. et al. Attenuation of adenosine-induced myocardial perfusion heterogeneity by atenolol and other cardioselective beta-adrenoceptor blockers: a crossover myocardial perfusion imaging study. J Nucl Med 2010; 51: 1036-1043
    CrossrefPubMedGoogle Scholar
  • 23 Hoffmeister C, Preuss R, Weise R. et al. The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging. J Nucl Cardiol 2014; 21: 1223-1229
    CrossrefPubMedGoogle Scholar
  • 24 Smits P, Lenders JW, Thien T. Caffeine and theophylline attenuate adenosine induced vasodilation in humans. Clin Pharmacol Ther 1990; 48: 410-418
    CrossrefPubMedGoogle Scholar
  • 25 Bottcher M, Czernin J, Sun KT. et al. Effect of caffeine on myocardial blood flow at rest and during pharmacological vasodilation. J Nucl Med 1995; 36: 2016-2021
    PubMedGoogle Scholar
  • 26 Hesse B, Tagil K, Cuocolo A. et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005; 32: 855-897
    CrossrefPubMedGoogle Scholar
  • 27 Knuuti J, Bengel F, Bax JJ. et al. Risks and benefits of cardiac imaging: an analysis of risks related to imaging for coronary artery disease. Eur Heart J 2014; 35: 633-638
    CrossrefPubMedGoogle Scholar
  • 28 Bundesamt für Strahlenschutz. Bekanntmachung der aktualisierten diagnostischen Referenzwerte für nuklearmedizinische Untersuchungen vom 25. September 2012. BAnz AT 19.10.2012 B5.
    PubMed
  • 29 Hyafil F, Gimelli A, Slart RHJA. et al. EANM procedural guidelines for myocardial perfusion scintigraphy using cardiac-centered gamma cameras. European J Hybrid Imaging 2019; 3: 11
    CrossrefPubMedGoogle Scholar
  • 30 Einstein AJ, Blankstein R, Andrews H. et al. Comparison of image quality, myocardial perfusion, and left ventricular function between standard imaging and single-injection ultra-lowdose imaging using a high-efficiency SPECT camera: the MILLISIEVERT study. J Nucl Med 2014; 55: 1430-1437
    CrossrefPubMedGoogle Scholar
  • 31 Songy B, Guernou M, Hivoux D. et al. Prognostic value of one millisievert exercise myocardial perfusion imaging in patients without known coronary artery disease. J Nucl Cardiol 2018; 25: 120-130
    CrossrefPubMedGoogle Scholar
  • 32 Giorgetti A, Rossi M, Stanislao M. et al. Feasibility and diagnostic accuracy of a gated SPECT early imaging protocol: a multicenter study of the Myoview Imaging Optimization Group. J Nucl Med 2007; 48: 1670-1675
    CrossrefPubMedGoogle Scholar
  • 33 Hara M, Monzen H, Futai R. et al. Reduction of infracardiac intestinal activity by a small amount of soda water in technetium-99m tetrofosmin myocardial perfusion scintigraphy with adenosine stress. J Nucl Cardiol 2008; 15: 241-245
    CrossrefPubMedGoogle Scholar
  • 34 Druz RS, Akinboboye OA, Grimson R. et al. Postischemic stunning after adenosine vasodilator stress. J Nucl Cardiol 2004; 11: 534-541
    CrossrefPubMedGoogle Scholar
  • 35 Hachamovitch R, Rozanski A, Hayes SW. et al. Predicting therapeutic benefit from myocardial revascularization procedures: are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary?. J Nucl Cardiol 2006; 13: 768-778
    CrossrefPubMedGoogle Scholar
  • 36 Hendel RC, Corbett JR, Cullom SJ. et al. The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine. J Nucl Cardiol 2002; 9: 135-143
    CrossrefPubMedGoogle Scholar
  • 37 Preuss R, Weise R, Lindner O. et al. Optimisation of protocol for low dose CT derived attenuation correction in myocardial perfusion SPECT imaging. Eur J Nucl Med Mol Imaging 2008; 35: 1133-1141
    CrossrefPubMedGoogle Scholar
  • 38 Sharir T, Bacher-Stier C, Dhar S. et al. Identification of severe and extensive coronary artery disease by post exercise regional wall motion abnormalities in Tc-99m sestamibi gated single-photon emission computed tomography. Am J Cardiol 2000; 86: 1171-1175
    CrossrefPubMedGoogle Scholar
  • 39 Hachamovitch R, Berman DS, Shaw LJ. et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998; 97: 535-543
    CrossrefPubMedGoogle Scholar