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Der Nuklearmediziner 2004; 27(3): 141-146
DOI: 10.1055/s-2004-822716
Kardiologie aktuell

© Georg Thieme Verlag Stuttgart · New York

Anforderungen des klinisch tätigen Kardiologen an die nuklearkardiologische Diagnostik

What the Clinical Cardiologist Requires from Cardiovascular Nuclear MedicineJ. vom Dahl1
  • 1Medizinische Klinik II (Kardiologie, Nephrologie, Internist. Intensivmedizin), Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach
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Publication History

Publication Date:
16 September 2004 (online)

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Zusammenfassung

Die Nuklearkardiologie in Deutschland steht derzeit an einem für ihre weitere Entwicklung wichtigen Punkt. Es gilt, die nachgewiesenen und unbestrittenen Stärken z. B. in der Diagnostik der KHK, der Prognoseabschätzung, der Vitalitätsdiagnostik und Fragen der ökonomischen Ressourcennutzung in den Vordergrund zu stellen und die Wertigkeit nuklearmedizinischer Verfahren in diesem Kontext der klinischen Öffentlichkeit besser bekannt zu machen. Im Gegensatz z. B. zu den angelsächsischen Ländern werden in Deutschland weniger Myokardszintigraphien als Koronarangiographien durchgeführt. Das bessere „Marketing” der Nuklearkardiologie, aber auch dem besseren „Service” für die klinisch tätigen Allgemeinärzte, Internisten und Kardiologen/innen in Form von kürzeren Wartezeiten, überweisergerechten Befundberichten sowie vermehrter interdisziplinärer Kommunikation kommt in naher Zukunft ein große Bedeutung zu, um die Nuklearkardiologie nicht durch neue Methoden in den Hintergrund drängen zu lassen.

Abstract

Nuclear Cardiology in Germany is right now at an important step for its future development. It is necessary to increase the publicity to the clinical community with regard to the well known and appreciated strengths of nuclear cardiology. Diagnosis of coronary artery disease (CAD), assessment of prognosis in patients with CAD with or without a history of myocardial infarction, imaging of myocardial viability as well as economic aspects of diagnostic and therapeutic strategies have been validated in numerous studies involving thousands of patients. Clinical “Marketing” of these important aspects has to be significantly improved in the near future. The “service” to the clinical partners, such as general practitioners, internists or cardiologists, needs further improvement as well as interdisciplinary communication to avoid that nuclear cardiology will be replaced by other techniques such as MRI oder MSCT and to assure that nuclear cardiology will play an important role within the clinical work-up of patients with CAD as it has in countries like the US.

Schlüsselwörter

Myokardperfusionsszintigraphie - koronare Herzkrankheit - akutes Koronarsyndrom - Kosteneffizienz - klinische Kardiologie

Key words

Myocardial perfusion scintigraphy - coronary artery disease - acute coronary syndrome - cost-effectiveness - clinical cardiology

Literatur

  • 1 Zaret B L, Wackers F J. Nuclear cardiology (1).  N Engl J Med. 1993;  329 775-783
    CrossrefPubMedGoogle Scholar
  • 2 Zaret B L, Wackers F J. Nuclear cardiology (2).  N Engl J Med. 1993;  329 855-863
    CrossrefPubMedGoogle Scholar
  • 3 National Institute of Clinical Excellence .Myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction. Technology Appraisal 73. National Institute for Clinical Excellence, London 2003. www.nice.org.uk
    Google Scholar
  • 4 Kapur A, Latus K A, Davies G, Dhawan R T, Eastick S, Jarritt P H, Roussakis G, Young M C, Anagnostopoulos C, Bomanji J, Costa D C, Pennell D J, Prvulovich E M, Ell P J, Underwood S R. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study.  Eur J Nucl Med Mol Imaging. 2002;  29 1608-1616
    CrossrefPubMedGoogle Scholar
  • 5 Smanio P E, Watson D D, Segalla D L, Vinson E L, Smith W H, Beller G A. Value of gating of technetium-99m sestamibi single-photon emission computed tomographic imaging.  J Am Coll Cardiol. 1997;  30 1687-1692
    PubMedGoogle Scholar
  • 6 Heller G V, Links J, Bateman T M, Ziffer J A, Ficaro E, Cohen M C, Hendel R C. American Society of Nuclear Cardiology and Society of Nuclear Medicine joint position statement: Attenuation correction of myocardial perfusion SPECT scintigraphy.  J Nucl Cardiol. 2004;  11 229
    CrossrefPubMedGoogle Scholar
  • 7 Hendel R C, Corbett J R, Cullom S J, DePuey E G, Garcia E V, Bateman T M. 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
  • 8 Beller G A, Zaret B L. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease.  Circulation. 2000;  101 1465-1478
    PubMedGoogle Scholar
  • 9 Schaefers M. Methods and clinical applications in nuclear cardiology: a position statement.  Nuklearmedizin. 2002;  41 3-13
    PubMedGoogle Scholar
  • 10 Underwood S R, Anagnostopoulos C, Cerqueira M, Ell P J, Flint E J, Harbinson M, Kelion A D, Al-Mohammad A, Prvulovich E M, Shaw L J, Tweddel A C. Myocardial perfusion scintigraphy: the evidence. A consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society, endorsed by the Royal College of Physicians of London and the Royal College of Radiologists.  Eur J Nucl Med Mol Imaging. 2004;  31 261-291
    CrossrefPubMedGoogle Scholar
  • 11 Hachamovitch R, Berman D S, Kiat H, Bairey C N, Cohen I, Cabico A, Friedman J, Germano G, Van Train K F, Diamond G A. Effective risk stratification using exercise myocardial perfusion SPECT in women: gender-related differences in prognostic nuclear testing.  J Am Coll Cardiol. 1996;  28 34-44
    CrossrefPubMedGoogle Scholar
  • 12 Shaw L J, Hachamovitch R, Redberg R F. Current evidence on diagnostic testing in women with suspected coronary artery disease: choosing the appropriate test.  Cardiol Rev. 2000;  8 65-74
    PubMedGoogle Scholar
  • 13 Wackers F J, Zaret B L. Detection of myocardial ischemia in patients with diabetes mellitus.  Circulation. 2002;  105 5-7
    PubMedGoogle Scholar
  • 14 Wackers F J. Can acute rest imaging shorten evaluation in chest pain centers?.  J Nucl Cardiol. 1999;  6 676-678
    CrossrefPubMedGoogle Scholar
  • 15 Heller G V, Stowers S A, Hendel R C, Herman S D, Daher E, Ahlberg A W, Baron J M, Mendes de Leon C F, Rizzo J A, Wackers F J. Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms.  J Am Coll Cardiol. 1998;  31 1011-1017
    CrossrefPubMedGoogle Scholar
  • 16 Abbott B G, Abdel-Aziz I, Nagula S, Monico E P, Schriver J A, Wackers F J. Selective use of single-photon emission computed tomography myocardial perfusion imaging in a chest pain center.  Am J Cardiol. 2001;  87 1351-1355
    CrossrefPubMedGoogle Scholar
  • 17 Udelson J E, Beshansky J R, Ballin D S, Feldman J A, Griffith J L, Handler J, Heller G V, Hendel R C, Pope J H, Ruthazer R, Spiegler E J, Woolard R H, Selker H P. Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial.  Jama. 2002;  288 2693-2700
    CrossrefPubMedGoogle Scholar
  • 18 Hachamovitch R, Berman D S. New frontiers in risk stratification using stress myocardial perfusion single photon emission computed tomography.  Curr Opin Cardiol. 2003;  18 494-502
    PubMedGoogle Scholar
  • 19 Van de Werf F, Ardissino D, Betriu A, Cokkinos D V, Falk E, Fox K A, Julian D, Lengyel M, Neumann F J, Ruzyllo W, Thygesen C, Underwood S R, Vahanian A, Verheugt F W, Wijns W. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology.  Eur Heart J. 2003;  24 28-66
    PubMedGoogle Scholar
  • 20 Shaw L J, Hendel R, Borges-Neto S, Lauer M S, Alazraki N, Burnette J, Krawczynska E, Cerqueira M, Maddahi J. Prognostic value of normal exercise and adenosine 99mTc-tetrofosmin SPECT imaging: results from the multicenter registry of 4 728 patients.  J Nucl Med. 2003;  44 134-139
    PubMedGoogle Scholar
  • 21 Hachamovitch R, Berman D S, Shaw L J, Kiat H, Cohen I, Cabico J A, Friedman J, Diamond G A. 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
  • 22 Bax J J, van Eck-Smit B L, van der Wall E E. Assessment of tissue viability: clinical demand and problems.  Eur Heart J. 1998;  19 847-858
    CrossrefPubMedGoogle Scholar
  • 23 Schinkel A F, Bax J J, Boersma E, Elhendy A, Roelandt J R, Poldermans D. How many patients with ischemic cardiomyopathy exhibit viable myocardium?.  Am J Cardiol. 2001;  88 561-564
    CrossrefPubMedGoogle Scholar
  • 24 Cleland J G, Pennell D J, Ray S G, Coats A J, Macfarlane P W, Murray G D, Mule J D, Vered Z, Lahiri A. Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomised controlled trial.  Lancet. 2003;  362 14-21
    CrossrefPubMedGoogle Scholar
  • 25 Tillisch J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps M, Schelbert H. Reversibility of cardiac wall-motion abnormalities predicted by positron tomography.  N Engl J Med. 1986;  314 884-888
    PubMedGoogle Scholar
  • 26 Schwaiger M, Beanlands R, vom Dahl J. Metabolic tissue characterization in the failing heart by positron emission tomography.  Eur Heart J. 1994;  15 (Suppl D) 14-19
    PubMedGoogle Scholar
  • 27 vom Dahl J, Schulz G, Koch K C. Diagnostik der chronischen Myokardischämie: Validität nuklearmedizinischer Verfahren.  Z Kardiol. 1998;  87 (Suppl 2) 92-99
    CrossrefPubMedGoogle Scholar
  • 28 Bax J J, van der Wall E E. Evaluation of myocardial viability in chronic ischemic cardiomyopathy.  Int J Cardiovasc Imaging. 2003;  19 137-140
    PubMedGoogle Scholar
  • 29 Allman K C, Shaw L J, Hachamovitch R, Udelson J E. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis.  J Am Coll Cardiol. 2002;  39 1151-1158
    CrossrefPubMedGoogle Scholar
  • 30 Schwarz E R, Schaper J, vom Dahl J, Altehoefer C, Grohmann B, Schoendube F, Sheehan F H, Uebis R, Buell U, Messmer B J, Schaper W, Hanrath P. Myocyte degeneration and cell death in hibernating human myocardium.  J Am Coll Cardiol. 1996;  27 1577-1585
    CrossrefPubMedGoogle Scholar
  • 31 Beanlands R S, Hendry P J, Masters R G, de Kemp R A, Woodend K, Ruddy T D. Delay in revascularization is associated with increased mortality rate in patients with severe left ventricular dysfunction and viable myocardium on fluorine 18-fluorodeoxyglucose positron emission tomography imaging.  Circulation. 1998;  98 1151-1156
    PubMedGoogle Scholar
  • 32 Bax J J, Schinkel A F, Boersma E, Rizzello V, Elhendy A, Maat A, Roelandt J R, van der Wall E E, Poldermans D. Early versus delayed revascularization in patients with ischemic cardiomyopathy and substantial viability: impact on outcome.  Circulation. 2003;  108 (Suppl 1) 1139-1142
    CrossrefPubMedGoogle Scholar
  • 33 Shaw L J, Hachamovitch R, Heller G V, Marwick T H, Travin M I, Iskandrian A E, Kesler K, Lauer M S, Hendel R, Borges-Neto S, Lewin H C, Berman D S, Miller D. Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients. The Economics of Noninvasive Diagnosis (END) Study Group.  Am J Cardiol. 2000;  86 1-7
    PubMedGoogle Scholar
  • 34 Shaw L J, Miller D D, Berman D S, Hachamovitch R. Clinical and economic outcomes assessment in nuclear cardiology.  Q J Nucl Med. 2000;  44 138-152
    PubMedGoogle Scholar
  • 35 Underwood S R, Godman B, Salyani S, Ogle J R, Ell P J. Economics of myocardial perfusion imaging in Europe - the EMPIRE Study.  Eur Heart J. 1999;  20 157-166
    CrossrefPubMedGoogle Scholar
  • 36 Desideri A, Fioretti P M, Cortigiani L, Gregori D, Coletta C, Vigna C, Tota F, Rambaldi R, Bax J, Celegon L, Bigi R, Picano E. Cost of strategies after myocardial infarction (COSTAMI): a multicentre, international, randomized trial for cost-effective discharge after uncomplicated myocardial infarction.  Eur Heart J. 2003;  24 1630-1639
    CrossrefPubMedGoogle Scholar
  • 37 Hendel R C, Wackers F J, Berman D S, Ficaro E, Depuey E G, Klein L, Cerqueira M. American society of nuclear cardiology consensus statement: reporting of radionuclide myocardial perfusion imaging studies.  J Nucl Cardiol. 2003;  10 705-708
    CrossrefPubMedGoogle Scholar
  • 38 Vermeeren P C. Nuclear cardiology in Europe: nuclear medicine physicians tend to build walls around their skills and thereby limit the growth of the field.  J Nucl Cardiol. 1999;  6 241-244
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. Jürgen vom Dahl(Sprecher der Arbeitsgruppe „Nuklearkardiologische Diagnostik” der Deutschen Gesellschaft für Kardiologie) 

Medizinische Klinik II (Kardiologie, Nephrologie, Internist. Intensivmedizin) · Krankenhaus St. Franziskus · Kliniken Maria Hilf GmbH

Viersener Straße 450

41063 Mönchengladbach

Phone: +49/21 61/8 92 22 31

Fax: +49/21 61/8 92 22 32

Email: vomdahlj@mariahilf.de