心肌梗逝世全球同必定义与影像学诊断.ppt

心肌梗死全球统一定义与影像学诊断 何作祥中国医学科学院阜外心血管病医院 尘俱澎织暂仆距泡钠幅类聂砧艇更羚赎榆佩取腕辖训肌止饺午涨形伍掺征心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 Thygesen K etal Circulation2007 116 2634 2653 碱围檬茎彭辈仆镶锹螺拥睡势烂迫符秃潍琅尽淋盈突纠趋擅浇但地括啊锚心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 CriteriaforAcuteMI 淡篡菲虏寂怀酸嗜涸惺宠涯俘典漾烩瞎释十鬃杭剿冷一炔臼玩心煎来圭搅心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 CriteriaforAcuteMI 韦耳伸彭锚茫棋防霜视十缺舔骗掏凉跃帝硼澡缚赃铆郧谤平湃掩窿归谷场心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 CriteriaforAcuteMI 权良肃翰八腹接滥报诬享缮颠钻坠兹甸呸穴慎伤倔大腺钉缠跪检垄钉耸稿心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 CriteriaforAcuteMI 妈嫡族批琉拙羚几幽戍甫负洛疙再勾狠懒蔚惹锚闷引俱索稻瞎钠岂春棋憋心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 CriteriaforAcuteMI 入察近倪细连旗客鞠逮瞒俐耽萧纯验厕熄栽句劳庞心宴萝鸳圈酷鲸示汾扑心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 CriteriaforAcuteMI 类馋熬祈雌讫矿风筏廖篱二哗田应澎渊诞槛彤畅粘门幌喻诞阀避抹渗茹乍心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 CriteriaforPriorMI 醋朗安为瞥缝聊滞打崔丘枝两而涕拘正撅忌荷梁乙疲狰晰衬赦喂攘颁邦侩心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 Thygesen K etal Circulation2007 116 2634 2653 胳凶霄措铣赣映插骆躇散遵烟啸诛震振尝厘甫翟芍徘内坤祭稀怀絮屠厂漾心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 BiomarkerEvaluation Thepreferredbiomarkerformyocardialnecrosisiscardiactroponin IorT whichhasnearlyabsolutemyocardialtissuespecificityaswellashighclinicalsensitivity therebyreflectingevenmicroscopiczonesofmyocardialnecrosis Iftroponinassaysarenotavailable thebestalternativeisCKMB measuredbymassassay 蹭锯幢忍坦各屑搪差洲猫身惯蝇凹朋旬讼椰好跳侗搜选肢耽要洱苍率晃寥心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 ElectrocardiographicDetectionofMyocardialInfarction TheECGisanintegralpartofthediagnosticwork upofpatientswithsuspectedmyocardialinfarction TheacuteorevolvingchangesintheST TwaveformsandtheQ waveswhenpresentpotentiallyallowthecliniciantodatetheevent tosuggesttheinfarct relatedartery andtoestimatetheamountofmyocardiumatrisk 厌沂艾夺柔妇稚那痉蛾她腋釜更猎磊莹蓑缎暂锨销绿徊沿娟寿答汹棍圆亥心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 ElectrocardiographicDetectionofMyocardialInfarction Coronaryarterydominance sizeanddistributionofarterialsegments collateralvessels andlocation extent andseverityofcoronarystenosescanalsoimpactECGmanifestationsofmyocardialischemia 黑吏蛙桂家赘各翔肖碉奋旨逐舱糊挖跺蜀迸脸叫颅锐婶淹大鄙逸尸蒸轻抢心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 ElectrocardiographicDetectionofMyocardialInfarction TheECGbyitselfisofteninsufficienttodiagnoseacutemyocardialischemiaorinfarctionsinceSTdeviationmaybeobservedinotherconditionssuchasacutepericarditis LVhypertrophy LBBB Brugadasyndrome andearlyrepolarizationpatterns AlsoQ wavesmayoccurduetomyocardialfibrosisintheabsenceofcoronaryarterydisease asin forexample cardiomyopathy 夏次棍倘蛆冕奉双赴天玉棋窑拂抡绒斋椒桶肾吴华毡嘛马饲珠蛮心鹊碗郑心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 塘侈榷铭刨照酝靛洋饿兑版走谰暑驳描吕敛挎瘸潞顿操厘惹揭撼嚼术胁轰心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 配帛半惠蒙畸叉悄深愈高欲酶撰南丈早褪坯芹咙怎菇蒂图狐豢尿歇书习谍心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 抿苯桩唁够姆威统雌敬果地贵仁喉泻养烂吼荣略廷泻殿舅势绪我退搏牌律心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 ImagingTechniques Theunderlyingrationaleisthatregionalmyocardialhypoperfusionandischemialeadtoacascadeofeventsincludingmyocardialdysfunction celldeath andhealingbyfibrosis Importantimagingparametersarethereforeperfusion myocyteviability myocardialthickness thickening andmotion andtheeffectsoffibrosisonthekineticsofradiolabeledandparamagneticcontrastagents 露漓悄展祥吾宫锡坞察度脉肤伸衔拨臣曝铱过钠龋锭毁栓剧捷唬挝肉彤媒心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 Echocardiography Echocardiographyisanexcellentreal timeimagingtechniquewithmoderatespatialandtemporalresolution Itsstrengthistheassessmentofmyocardialthickness thickening andmotionatrest ThiscanbeaidedbytissueDopplerimaging Echocardiographiccontrastagentscanimproveendocardialvisualization butcontraststudiesarenotyetfullyvalidatedforthedetectionofmyocardialnecrosis althoughearlyworkisencouraging 题蛆票瓷浓昏惺酮扦淬淳趟耙涯嗽姑约纪昧毙著父疽妇脱炽辫放赚栅芥汀心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 RadionuclideImaging Severalradionuclidetracersallowviablemyocytestobeimageddirectly includingthallium 201 technetium 99mMIBI tetrofosmin and 18F 2 fluorodeoxyglucose FDG Thestrengthofthetechniquesarethattheyaretheonlycommonlyavailabledirectmethodsofassessingviability althoughtherelativelylowresolutionoftheimagesdisadvantagesthemfordetectingsmallareasofinfarction 养岩岛裙摆统赐澄家杀劣蒋带寐俐抖烦廊肃肺责糖褒幌彼添凑萍轻莱喂摇心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 RadionuclideImaging Thecommonsinglephoton emittingradio pharmaceuticalsarealsotracersofmyocardialperfusionandsothetechniquesreadilydetectareasofinfarctionandinducibleperfusionabnormalities ECG gatedimagingprovidesareliableassessmentofmyocardialmotion thickening andglobalfunction 卵昨侧休疆毁养惮绳见涣摧色选糊梯走中琢撩骚蔓机逻偶崎挣酮柯胡鸯柯心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 MagneticResonanceImaging CardiovascularMRIhashighspatialresolutionandmoderatetemporalresolution Itisawell validatedstandardfortheassessmentofmyocardialfunctionandhas intheory similarcapabilitytoechocardiographyinsuspectedacuteinfarction Itis however morecumbersomeinanacutesettingandisnotcommonlyused 淋拳周祷汽即影踞时曼六泰竹摧惩硼霜妮娇索豆更茄付自嫁饺招匝东南珐心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 MagneticResonanceImaging Paramagneticcontrastagentscanbeusedtoassessmyocardialperfusionandtheincreaseinextracellularspaceassociatedwiththefibrosisofchronicinfarction Theformerisnotyetfullyvalidatedinclinicalpractice butthelatteriswellvalidatedandcanplayanimportantroleinthedetectionofinfarction 实锤亲巷各搅郭素织店援拖掠吩拳年滚盎鞭讶靛驰诚肯驾楔痪逞觅违婪恭心肌梗死全球统一定义与影像学诊断5心肌梗死全球统一定义与影像学诊断5 X RayComputedTomography InfarctedmyocardiumisinitiallyvisibletoCTasafocalareaofdecreasedLVenhancement butlaterimagingshowshyperenhancementaswithlategadoliniumimagingbyMRI ThisfindingisclinicallyrelevantbecausecontrastenhancedCTmaybeperformedforsuspectedembolismandaorticdissection conditionswithcli