Nicht invasive kardiologische Bildgebung bei Herzinsuffizienz

Abstract

Heart failure is the fastest growing cardiac diagnosis in Europe with an incidence of 10 cases per 1000 people in individuals older than 65. The vital role of cardiac imaging in the management of patients with heart failure continues to grow. As many novel imaging markers emerge, it becomes difficult for clinicians to choose the imaging tests that can best aid clinical decisions for a given patient. Echocardiography remains a first-line test in heart failure and continues to provide valuable information on left ventricular and valvular function. Single-photon emission computed tomography (SPECT) is routinely used to detect ischemia. However, there is increasing evidence to support the use of other imaging modalities, cardiovascular magnetic resonance (CMR), positron emission tomography (PET) and computed tomography (CT), to assist heart failure physicians with clinical decision making. In this review, we summarize the most recent developments relevant to heart failure.

Kernaussagen

• Die Herzinsuffizienz zeigt in den westlichen Industrienationen eine stark zunehmende Prävalenz und eine Inzidenz von annähernd 10 Patienten pro 1000 Individuen, die älter als 65 Lebensjahre sind.

• Die Therapie der HIS ist zunehmend komplexer und bedarf der genauen Indikationsstellung und des exakten Monitorings. Dieses Monitoring gelingt zunehmend mit sog. Biomarkern, also charakteristisch und objektiv messbaren Indikatoren biologischer und pathologischer Prozesse. Hier erfüllt neben den serologischen Biomarkern wie z. B. ANP, BNP oder NT-pro BNP die moderne Bildgebung eine wichtige Rolle, in dem sie eine große Anzahl neuer morphologischer und funktioneller Marker bietet, die mittels verschiedener Bildgebungsverfahren dargestellt und gemessen werden können.

• Im Rahmen der klinischen HIS haben sich hierbei im Wesentlichen die Echokardiografie und das Kardio-MRT als sinnvoll erwiesen, wobei beide Verfahren aufgrund ihrer unterschiedlichen Vor- und Nachteile durchaus als komplementär anzusehen sind. Die höhere zeitliche Auflösung der Echokardiografie machen diese Technik besonders wertvoll in der Bestimmung der diastolischen Funktionsstörung, während die höhere räumliche Auflösung und die Möglichkeit der Anwendung unterschiedlicher MRT-Sequenzen (T1-, T2-Wichtung, Mapping, LGE) das Kardio-MRT besonders für die Beurteilung der systolischen Funktion, der Morphologie und der Gewebecharakterisierung empfehlen. Obwohl die Kardio-MRT nur begrenzt zugänglich und kosten- und personalintensiv ist, kompliziert in der Anwendung erscheint und Kontraindikationen wie Herzschrittmacher und Defibrillatoren bedacht werden müssen, ist sie doch eine wertvolle Alternative und Ergänzung zur Echokardiografie.

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