五洲会何作祥核心脏病学现状与进展a课件.ppt

五洲会何作祥核心脏病学现状与进展a课件
第一页，共三十一页。
Accuracy of Noninvasive Test for Diagnosis of CAD
No. of Studies
No. of Patientl chest pain
476 ()
Typical chest pain
112 ()
第十三页，共三十一页。
Accuracy of luminal stenosis by coronary CTA for detecting abnormal MPI
*
Stenosis
Sensitivity*
Specificity*
PPV*
NPV**
Patients’ Level
≥50%




≥75%




≥90%


73

Vascular Level
≥50%




≥75%




≥90%

99


第十四页，共三十一页。
CTA and SPECT/ CTA for Detection of Hemodynamically Significant Coronary Lesions
Rispler JACC 2007; 49: 1059-67
0
50
100
Percent
Sens Spec PPV NPV
Sens Spec PPV NPV
CTA
SPECT/ CTA
96
96
99
99
63
95
31
77
第十五页，共三十一页。
PET/CT in CAD
Namdar M, et al. JNM 2005
第十六页，共三十一页。
Myocardial Infarctions are causedby Low-Grade Stenoses
Pooled data from 4 studies: Ambrose et al, 1988; Little et al, 1988; Nobuyoshi et al, 1991; and Giroud et al, 1992.(Adapted from Falk et al.)
第十七页，共三十一页。
Risk Stratification
Low
<1% per year
Intermediate
1-3% per year
High
>3% per year
Adapted from Gibbons RJ, et al. J Am Coll Cardiol. 1999;33:2092-2197.
Risk of Cardiac Death:
第十八页，共三十一页。
Risk Stratification: Noninvasive Testing Markers
Amount of infarcted myocardium
Amount of jeopardized myocardium
Degree of jeopardy
第十九页，共三十一页。
Risk Stratification: Noninvasive Testing Markers
Left ventricular systolic function
第二十页，共三十一页。
Predictors of cardiac mortality
factors estimating the extent of LV dysfunction
LVEF
the extent of infarcted myocardium
transient ischemic dilation of the LV
and increased lung uptake
第二十一页，共三十一页。
Predictors of the subsequent development of acute ischemic syndromes
markers of provocative ischemia
exertional symptoms,
electrocardiographic changes
the extent of reversible perfusion defects
stress-induced ventricular dyssyne