Данная статья посвящена современным методам сердечно-сосудистой визуализации для диагностики ишемической болезни сердца (ИБС). Методы ядерной кардиологии, стресс-эхокардиография, мультиспиральная компьютерная томография и магнитно-резонансная томография обладают высокими показателями чувствительности и специфичности в верификации коронарной патологии. Они рекомендуются пациентам с промежуточной предтестовой вероятностью ИБС на основании оценки клинической симптоматики и факторов риска. Дополнительно у больных с ИБС современные методы визуализации полезны для оценки жизнеспособности миокарда.
This article is devoted to the role of the modern methods of cardiovascular imaging in the diagnosis of ischemic heart disease (IHD). Stress echocardiography, multislice computed tomography, magnetic resonance imaging and methods of nuclear cardiology have a high sensitivity and specificity in the verification of IHD. They are recommended for patients with intermediate pretest probability of IHD based on the evaluation of clinical symptoms and risk factors. Additionally, in patients with ischemic heart disease modern imaging techniques are useful for evaluation of myocardial viability.
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1. Bolezni serdtsa po Braunval'du. Rukovodstvo po serdechno-sosudistoi meditsine. Pod red. P.Libbi. V 4 t. T. 1. M.: Rid Elsiver, 2010. [in Russian]
2. 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 (38): 2949–3003.
3. Achenbach S, Dilsizian V, Kramer CM, Zoghbi WA. The year in coronary artery disease. JACC Cardiovasc Imaging 2009; 2 (6): 774–86.
4. Lancellotti P, Płońska-Gościniak E, Garbi M et al. Cardiovascular imaging practice in Europe: a report from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16 (7): 697–702.
5. Fraser AG, Buser PT, Bax JJ et al. The future of cardiovascular imaging and non-invasive diagnosis: a joint statement from the European Association of Echocardiography, the Working Groups on Cardiovascular Magnetic Resonance, Computers in Cardiology, and Nuclear Cardiology, of the European Society of Cardiology, the European Association of Nuclear Medicine, and the Association for European Paediatric Cardiology. Eur Heart J 2006; 27 (14): 1750–3.
6. Nicholls SJ, Andrews J, Puri R et al. Imaging progression of coronary atherosclerosis. Circ J 2013; 77 (1): 3–10.
7. Nikiforov V.S., Nikitin A.E., Tyrenko V.V., Svistov A.S. Ishemicheskaia disfunktsiia miokarda. M.: APKiPPRO. 2005. [in Russian]
8. Garcia MJ. Cardiac CT for CAD. Do we still need angiography? J Cardiovasc Surg (Torino) 2009; 50 (1): 7–17.
9. Mark DB, Shaw LJ, Lauer MS et al. 34th Bethesda Conference: Task force #5 – Is atherosclerosis imaging cost effective? J Am Coll Cardiol 2003; 41 (11): 1906–17.
10. Arkhipova I.M., Mershina E.A., Sinitsyn V.E. Rol' KT-koronarografii v diagnostike IBS na ambulatornom etape. Poliklinika. 2013; 3–1: 18–21. [in Russian]
11. Sun Z, Moudi M, Cao Y. CT angiography in the diagnosis of cardiovascular disease: a transformation in cardiovascular CT practice. Quant Imaging Med Surg 2014; 4 (5): 376–96.
12. Greenland P, Bonow RO, Brundage BH et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation 2007; 115 (3): 402–26.
13. Marwan M, Ropers D, Pflederer T et al. Clinical characteristics of patients with obstructive coronary lesions in the absence of coronary calcification: an evaluation by coronary CT angiography. Heart 2009; 95: 1056–60.
14. Ternovoi S.K., Nikonova M.E., Akchurin R.S. i dr. Vozmozhnosti mul'tispiral'noi komp'iuternoi tomografii (MSKT) v otsenke koronarnogo rusla i ventrikulografii v sravnenii s interventsionnoi koronaroventrikulografiei. Ros. elektronnyi zhurn. luchevoi diagnostiki. 2013; 3 (1): 28–36. [in Russian]
15. Abbara S, Arbab-Zadeh A, Callister TQ et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2009; 3: 190–204.
16. Vavere AL, Arbab-Zadeh A, Rochitte CE et al. Coronary artery stenoses: accuracy of 64-detector row CT angiography in segments with mild, moderate, or severe calcification: a subanalysis of the CORE-64trial.Radiology 2011; 261: 100–8.
17. Nesto RW, Kowalchuk GJ. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 1987; 59 (7): 23C–30C.
18. Hyodo E, Muro T, Hozumi T et al. Observation of the ischemic cascade in humans using contrast echocardiography during dobutamine stress. Circ J 2003; 67 (5): 406–10.
19. Charoenpanichkit C, Hundley WG. The 20 year evolution of dobutamine stress cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12: 59.
20. Mieres JH, Makaryus AN, Redberg RF, Shaw LJ. Noninvasive cardiac imaging. Am Fam Physician 2007; 75 (8): 1219–28.
21. Zakharova A.I., Nikiforov V.S., Svistov A.S. Diagnosticheskie vozmozhnosti ekhokardiografii u bol'nykh ishemicheskoi bolezn'iu serdtsa. Regionarn. krovoobrashchenie i mikrotsirkuliatsiia. 2007; 6 (4): 78–85. [in Russian]
22. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16 (3): 233–70.
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Авторы
В.С.Никифоров
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 viktor.nikiforov@szgmu.ru
________________________________________________
V.S.Nikiforov
I.I.Mechnikov State Northwestern Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation, Saint Petersburg, ul. Kirochnaia, d. 41 viktor.nikiforov@szgmu.ru