核素门控心功能PFR假性正常化鉴别与舒张功能精准评估——多模态整合进展

Differential Diagnosis of Pseudonormalization of Radionuclide Gated Cardiac Function PFR and Accurate Evaluation of Diastolic Function—Advances in Multimodal Integration

摘要: 目的：系统梳理核素门控心功能峰值充盈率(PFR)评估左心室舒张功能的临床标准，聚焦PFR假性正常化的病理机制与鉴别难点，结合心脏超声、无创影像及有创血流动力学最新进展，构建以PFR联合心肌灌注为核心的舒张功能精准分层方案。方法：以“核素门控心功能、峰值充盈率、假性正常化、舒张功能不全、心肌灌注显像、E/e’”为中文关键词，以“radionuclide gated ventricular function、peak filling rate、pseudonormalization、diastolic dysfunction、myocardial perfusion imaging、E/e’”为英文关键词，检索PubMed、Web of Science、CNKI、万方等数据库近5年高质量文献，纳入指南、临床研究、综述与技术进展，重点提炼PFR判读阈值、假性正常化机制、多模态指标互补及灌注联合鉴别策略。结果 临床通用PFR < 2.5 EDV/s为舒张功能轻度降低标准；PFR > 2.5包含真正常与假性正常化，后者对应中度舒张功能异常，因左房压力代偿升高致充盈速率回升，易漏诊。2024~2025年ASE/EACVI指南推荐E/A、e’、E/e’、左房容积指数(LAVI)为超声核心指标，E/e’ ≥ 15是充盈压升高与假性正常化的关键佐证。心脏磁共振T1 mapping、细胞外容积可量化纤维化，有创测压为金标准。核素门控心肌灌注显像(G‑MPI)实现灌注与功能一站式评估，灌注异常是鉴别PFR假性正常化的核心线索：PFR > 2.5 + 灌注正常 + E/e’正常为真正常；PFR > 2.5 + 灌注异常/缺血 + E/e’ ≥ 15判定为假性正常化(中度异常)。结论：PFR是无创评估舒张功能稳定参数，单一PFR > 2.5无法区分真正常与假性正常化。PFR联合心肌灌注并整合超声E/e’等指标，可精准实现舒张功能分层，避免中度异常漏诊，为冠心病、心衰早期诊疗提供核医学规范化路径。

Abstract: Objective: To systematically summarize the clinical criteria of peak filling rate (PFR) derived from radionuclide gated ventricular function imaging for left ventricular diastolic function evaluation, focus on the pathological mechanism and differential dilemmas of PFR pseudonormalization, and establish a precise stratification strategy for diastolic function based on PFR combined with myocardial perfusion integrated with the latest advances in echocardiography, non-invasive imaging and invasive hemodynamics. Methods: Literatures in the past 5 years were retrieved from PubMed, Web of Science, CNKI, Wanfang and other databases with Chinese and English keywords related to radionuclide ventricular function, PFR, pseudonormalization, diastolic dysfunction and myocardial perfusion imaging. Guidelines, clinical studies, reviews and technical advances were included to analyze PFR threshold, pseudonormalization mechanism, multimodal indicators and perfusion combined differential strategy. Results: PFR < 2.5 EDV/s was commonly used as the standard for mild diastolic dysfunction; PFR > 2.5 included true normal and pseudonormalization, the latter corresponding to moderate diastolic dysfunction caused by compensatory elevation of left atrial pressure, which was easily misdiagnosed as normal. 2024~2025 ASE/EACVI guidelines recommended E/A, e’, E/e’ and left atrial volume index (LAVi) as core echocardiographic indicators, and E/e’ ≥ 15 indicated elevated filling pressure and strongly supported pseudonormalization. Cardiac magnetic resonance T1 mapping and extracellular volume could quantify interstitial fibrosis. Invasive hemodynamics was the gold standard. Gated myocardial perfusion imaging (G‑MPI) provided one‑stop evaluation of perfusion and function. Perfusion abnormality was the key to identify PFR pseudonormalization: PFR > 2.5 + normal perfusion + normal E/e’ indicated true normal; PFR > 2.5 + abnormal perfusion/ischemia + E/e’ ≥ 15 indicated pseudonormalization (moderate dysfunction). Conclusions: PFR is a stable noninvasive parameter for diastolic function. Single PFR > 2.5 cannot distinguish true normal from pseudonormalization. PFR combined with myocardial perfusion and echocardiographic E/e’ can accurately stratify diastolic function and reduce missed diagnosis of moderate abnormalities, providing a standardized nuclear medicine strategy for early diagnosis and treatment of coronary heart disease and heart failure.