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“Hibernating myocardium” — winterschlafendes Myokard: klinische Bedeutung

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Single-Photon-Emissions-Computertomographie (SPECT) des Herzens

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Zusammenfassung

Die regionale oder globale Einschränkung der Pumpfunktion ist ein gemeinsames und damit unspezifisches Merkmal vieler pathologischer Zustände des Myokards. Ursächlich kommen neben idiopathischen Kardiomyopathien, Erregungsausbreitungsstörungen und Sepsis v.a. vaskuläre — als ohnehin häufigste — Herzerkrankungen in Frage. Bei der makrovaskulären Form auf dem Boden einer Arteriosklerose zielen die akut interventionellen (intravenöse oder intrakoronare Lyse, Rescue-PTCA oder Notfall-ACVB-Operation) und die elektivinvasiven Therapiestrategien sowohl auf die Besserung der Symptomatik als auch auf die günstige Beeinflussung der Prognose. Groß angelegte Studien wie GISSI-2 [1] und ISIS-2 [2] zeigten, daß sowohl die erfolgreiche Thrombolyse nach akutem Infarkt als auch die elektive ACVB-Operation bei chronischer KHK eine signifikante Prognoseverbesserung erzielen, dies wohl hauptsächlich infolge der Verbesserung der ventrikulären Funktion [3]. Ebenso wird ein Zusammenhang von regionalem „Perfusions-Metabolismus-mismatch" und dem Auftreten von ventrikulären Tachykardien diskutiert [4]. Im Fall der chronischen stabilen oder instabilen KHK setzt die individuell optimierte Therapie eine rationale Diagnostik - primär die Erhebung des Koronarstatus - voraus. Häufig wird in dessen Kenntnis, anamnestischer Daten und des aktuellen klinischen Bildes bereits die Entscheidung, ob und welches Revaskularisationsverfahren zum Einsatz kommen soll, zu treffen sein. Es verbleibt jedoch eine Teilgruppe von Patienten, bei denen mit kon-ventionell-kardiologischen Methoden nicht festzulegen ist, ob die Reperfusion eines funktionsgeminderten Myokardareals die Normalisierung der regionalen Kontraktilität auf dem Boden einer überwiegend erhaltenen Myokardvitalität in Aussicht stellt. Dies gilt vermutlich ebenso für die PTCA wie für die ACVB-Operation, bei der das prognostische Ergebnis von mehreren Einflußfaktoren abhängt: In erster Linie von der perioperativen Mortalität bei Komplikationen, die bei älteren Patienten, bei Re-oder Notfalloperationen, bei Hauptstammstenosen und bei hochgradig eingeschränkter linksventrikulärer Ejektionsfraktion (LVEF) zunehmen. In Deutschland wurden 199128528 Patienten einer ACVB-Operation unterzogen, wobei die Mortalität innerhalb der ersten 30 Tage bei 2,6% lag [5]. In Kanada wurden in Abhängigkeit von der präoperativen LVEF entsprechende Werte zu 2,3% (LVEF > 40%), 4,8% (LVEF zwischen 40% und 20%) und 9,8% (LVEF < 20%) ermittelt [6].

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  1. Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany

    Helmut J. Wieler (Leitender Arzt der Abt. Nuklearmendizin) (Leitender Arzt der Abt. Nuklearmendizin)

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Stirner, H. (1997). “Hibernating myocardium” — winterschlafendes Myokard: klinische Bedeutung. In: Wieler, H.J. (eds) Single-Photon-Emissions-Computertomographie (SPECT) des Herzens. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60621-2_17

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