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DOI: 10.1055/a-2118-9537
Bildgebende Belastungsdiagnostik des Herzens
![](https://www.thieme-connect.de/media/kardiologie-u2d/202402/lookinside/thumbnails/10-1055-a-2118-9537-1.jpg)
Symptomatische Patienten mit Verdacht auf ein chronisches Koronarsyndrom sind häufig und die Kosten der diagnostischen Abklärung für das Gesundheitssystem erheblich. Bildgebende Verfahren stellen einen zentralen Teil der Diagnostik dar und ermöglichen sowohl Ausschluss eines CCS als auch den Nachweis einer hämodynamisch relevanten Stenose bzw. Myokardischämie. Folgend werden verschiedene Verfahren, deren Effektivität und Wirtschaftlichkeit vorgestellt.
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Die funktionellen bildgebenden Verfahren des Herzens haben einen maßgeblichen Stellenwert bei der Therapieentscheidung symptomatischer Patienten mit V. a. oder bereits bekanntem CCS.
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Sie sind entsprechend den aktuellen Leitlinien indiziert bei Patienten mit höherer klinischer Wahrscheinlichkeit für ein CCS oder bei bekanntem CCS, abhängig von lokaler Verfügbarkeit und Kompetenzen.
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Unter den im klinischen Umfeld relevanten Verfahren zeichnet sich die Stress-MRT durch ihre hohe diagnostische Genauigkeit aufgrund der guten räumlichen Auflösung und eine exzellente Narbenbildgebung aus.
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Die Stress-Echokardiografie, SPECT und PET-MPI sind weitere etablierte funktionelle Verfahren mit weitgehend vergleichbarer diagnostischer Genauigkeit.
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Insbesondere die Stress-Echokardiografie zeichnet sich durch die Möglichkeit der Erhebung weiterer relevanter Belastungsparameter des linken Ventrikels aus und kann als hoch verfügbare und kostengünstige Methode einen Mehrwert bieten.
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Im Bereich der ambulanten Versorgung spielt die SPECT aufgrund ihrer guten Standardisierung und Verfügbarkeit bisher die größte Rolle in Deutschland.
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Die PET-MPI und Perfusionsstress-CT haben eine exzellente diagnostische Aussagekraft aufgrund der Möglichkeit einer absoluten Quantifizierung der Perfusion, spielen in der klinischen Versorgung aktuell jedoch nur eine untergeordnete Rolle.
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Die CT hat methodisch das Potenzial, die morphologische und funktionelle Bildgebung mit der CT-Koronarangiografie und Perfusionsstress-CT zu vereinen.
Schlüsselwörter
Bildgebung - Diagnostik - CCS - Stress-MRT - Perfusionsstress-CT - fraktionierte Flussreserve - SPECT - PET - chronisches KoronarsyndromPublication History
Article published online:
01 July 2024
© 2024. Thieme. All rights reserved.
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