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Frühdiagnostik der funktionell relevanten koronaren Herzerkrankung

Early diagnosis of coronary heart disease

  • Schwerpunkt: Frühdiagnostik in der Inneren Medizin
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Zusammenfassung

Die koronare Herzkrankheit (KHK) ist nach angiographischen Kriterien definiert als das Vorliegen von Lumeneinengungen der Koronarien >50%. Die mit einer solchen Lumenreduktion einhergehenden hämodynamischen Veränderungen stellen heute die Grenze für die Nachweisbarkeit der KHK mit den sensitivsten funktionellen Untersuchungsverfahren der Ischämiediagnostik dar. Bei Verdacht auf das Vorliegen einer KHK oder atypischer Beschwerdesymptomatik wird die Indikationsstellung zur Herzkatheterdiagnostik durch eine Ischämiediagnostik abgesichert. Diese kann entweder durch ergometrische Belastungstests oder durch bildgebende Verfahren in Kombination mit ergometrischer oder pharmakologischer Belastung erfolgen. Etabliert sind die Myokardszintigraphie und die Stressechokardiographie sowie in zunehmenden Maße auch die Stressmagnetresonanztomographie. Neben dem sensitiven Ischämienachweis hat der technische Fortschritt in der Computertomographie (CT) und der Magnetresonanztomographie (MRT) die Möglichkeit einer nichtinvasiven Darstellung der Koronargefäße und der Gefäßwandmorphologie eröffnet. Während die CT-Koronarangiographie mit ihrer hohen räumlichen Auflösung an der Schwelle zur klinischen Anwendung bei selektierten Patienten steht, hat die MRT das Potenzial, von der Wandbewegungsanalyse über die Perfusion und Koronarflussmessung bis hin zur Plaquecharakterisierung zukünftig eine „kardiovaskuläre Rundumuntersuchung“ zu gewährleisten.

Abstract

In cases of stable or to a large extent symptom-free coronary heart disease (CHD) and atypical symptomatology, the indication for diagnostic cardiac catheterization is first confirmed by noninvasive diagnostics of ischemia. This can be carried out either with ergometric stress tests or imaging procedures in combination with ergometric or pharmacological stress. Myocardial scintigraphy and stress echocardiography are established techniques and to an increasing extent stress magnetic resonance imaging (MRI). In addition to sensitivity in providing evidence for ischemia, technical improvements in computed tomography (CT) and MRI have opened up new possibilities for visualizing coronary vessels and vascular wall morphology. While CT coronary angiography with its high spatial resolution is on the threshold of clinical application for selected patients, MRI has the potential for furnishing information on wall movement analysis, perfusion, coronary flow measurement, and plaque characterization to become the future cardiovascular “all-round examination”.

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  1. Klinik III für Innere Medizin, Universität zu Köln

    F. M. Baer

  2. Klinik III für Innere Medizin, Universität, Joseph-Stelzmann Straße 9, 50924, Köln

    F. M. Baer

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Baer, F.M. Frühdiagnostik der funktionell relevanten koronaren Herzerkrankung. Internist 46, 389–400 (2005). https://doi.org/10.1007/s00108-005-1368-y

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