Konventionelle nuklearmedizinische Diagnostik in der Nachsorge nach Herztransplantation

Zusammenfassung

Die 1-Jahres-Überlebensrate nach Herztransplantation liegt unter der Erhaltungstherapie mit Immunsuppressiva aktuell über 80%. Im ersten Jahr nach dem Eingriff stellen Rejektionskrisen und akute Infektionen die Haupttodesursachen dar. Danach ist die Lebenserwartung der Transplantatempfänger im wesentlichen durch eine für das transplantierte Herz charakteristische progrediente Angiopathie, die Graft-Arteriosklerose, limitiert. Die Graft-Arteriosklerose zeichnet sich aus durch eine fortschreitende Intimaverdickung in allen koronaren Gefäßsegmenten.

In der vorliegenden Übersicht werden die nuklearmedizinischen Verfahren vorgestellt, die bei der Diagnostik von Rejektion und vaskulären Komplikationen einen gewissen klinischen Stellenwert erlangt haben. Es sind dies die Immunszintigraphie mit ¹¹¹In-markierten monoklonalen Antikörpern gegen Myosin, die Radionuklidventrikulographie und die Perfusionsszintigraphie des Myokards. Die allmählich fortschreitende sympathische Reinnervation des Herzmuskels wird durch die Anreicherung von [¹²³l]-meta-lod-Benzylguanidin angezeigt.

Summary

Actually more than 80% of heart recipients survive the first postoperative year. Early death is mainly caused by rejection and acute infection. After the first year progressive graft atherosclerosis has the greatest impact on prognosis.

The review presents scintigraphic methods that have reached clinical Impact in the diagnosis of rejection and vascular complications. Immuno-scintigraphy with ¹¹¹1n-labelled monoclonal antibodies against myosin proved to be of importance in the diagnosis of rejection especially in long-term follow-up. Perfusion scintigraphy reveals vital and ischemic myocardium. In heart transplant recipients radionuclide ventriculography has been widely replaced by echocardiography. Up to now, the evaluation of increasing nerval integration with ¹²³I-MIBG has not reached clinical impact.

Schlüsselwörter

Herztransplantation - Nachsorge - Myokardszintigraphie - Radionuklidven-trikulographie

Keywords

Heart transplantation - follow-up - myocardial scintigraphy - radionuclide ventriculography

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