64排螺旋CT在冠心病诊断上的应用课件

64排螺旋CT在冠心病诊断上的应用

主任医师

ST.MICHAELHOSPITAL1在新加坡。。。

在中国。。。英年早逝震惊中国

河南17岁高中生两周前突然出现心脏猝死，2

没有任何迹象

没有胸部疼痛

发生在健康的人群中

在慢跑或长跑时

心脏病发作与突发性猝死

什么原因呢？。。。

3如何控制心脏病的发生如何预防冠心病的发生如何了解自己是否患有冠心病患有冠心病如何治疗健康活到100岁4传说

心脏病及中风只会发生在那些血管有严重阻塞的人身上

通常会发生在那些上了年纪的人群

5事实动脉血管的阻塞程度是由多年的累积所造成的大多数心脏病发作是由于血管壁的屯积物然破裂，血小板凝聚形成斑块而造成血管阻塞6LikelihoodofPlaqueRuptureDoesNOTcorrelatewiththeSeverityofCoronaryArteryStenosis冠状动脉狭窄的严重程度与血栓破裂没有关系7动脉粥样硬化管腔变窄血栓形成正常血管血管内皮损伤胆固醇聚集8原因。。。2/3的心脏病突然发作是因为心脏血管只有40-60%的阻塞阻塞不严重时是没有明显症状的对那些心血管阻塞程度已经超过70%的病患更需要例行常规检查9TopicsRiskFactorsofHeartDiseaseLatestFindingsinReducingHeartDiseaseLatestAdvancesinMedicalTechnologyinPreventingHeartDiseaseConclusion10Riskfactorsforstrokethatcan'tbechanged:不能改变的原因Age

年龄Heredity(familyhistory)

家族史Priorstroke,TIAorheartattack

以前发生过中风，一过性脑缺血，心脏病11Riskfactorsthatcanbechanged,treatedorcontrolled:可控制的因素Highbloodpressure

高血压Cigarettesmoking

吸烟Diabetesmellitus

糖尿病Carotidorotherarterydisease

颈动脉和其他血管疾病Otherheartdisease

心脏病Highbloodcholesterol

高血脂Poordiet

不健康的饮食习惯Physicalinactivityandobesity

缺乏运动及肥胖12MainCauseofHeartAttackisPlaque(FatDeposit)Rupture13心肌梗塞14EvolutionofNHLBISupportedGuidelinesAngiographictrials(FATS,POSCH,SCOR,STARS,Ornish,MARS)Meta-analyses

(Holme,Rossouw)NCEPATPI1988NCEPATPII1993NCEPATPIII2001HPS

PROVE-ITASCOT-LLAPROSPERALLHAT-LLTUpdatedNCEPATPIII2004Framingham

MRFIT

LRC-CPPT

Coronary

DrugProject

HelsinkiHeart

CLAS4S

WOSCOPS

CARE

LIPID

AFCAPS/

TexCAPSTNTIDEALAHA/ACCUpdate2006MoreIntensiveTreatmentRecommendationsNCEPATP=NationalCholesterolEducationPanelAdultTreatmentPanel.NHLBI=NationalHeart,Lung,andBloodInstitute.AHA=AmericanHeartAssociation.ACC=AmericanCollegeofCardiology.15AHA/ACCguidelinesforpatientswithCHD*,2<100mg/dL:GoalforallpatientswithCHD†,2<70mg/dL:AreasonablegoalforallpatientswithCHD†,2ATPIIIUpdate20041<100mg/dL:PatientswithCHDorCHDriskequivalents(10-yearrisk>20%)1<70mg/dL:Therapeuticoptionforveryhigh-riskpatients1IntensiveLDL-CGoalsfor

High-RiskPatients<100mg/dL<70mg/dL* Andotherformsofatheroscleroticdisease.2† Factorsthatplaceapatientatveryhighrisk:establishedcardiovasculardisesase(CVD)plus: multiplemajorriskfactors(especiallydiabetes);severeandpoorlycontrolledriskfactors(eg,cigarettesmoking);metabolicsyndrome(triglycerides[TG]≥200mg/dL+non–HDL-C≥130mg/dLwithHDL-C<40mg/dL);andacutecoronarysyndromes.11.GrundySMetal.Circulation.2004;110:227–239.2.SmithSCJretal.Circulation,2006;113:2363–2372.2006

UpdateRecommendedLDL-CtreatmentgoalsIfitisnotpossibletoattainLDL-C<70mg/dLbecauseofahighbaselineLDL-C,itgenerallyispossibletoachieveLDL-Creductionsof>50%withmoreintensiveLDL-C─loweringtherapy,includingdrugcombinations.1617WhichTestCan

DetectHeartDisease

EarlyandAccurately运用什么测试可以尽早的发现心脏病并得到精确的结论18METHODSOFDETECTIONSomeexamples:Electrocardiogram(ECG)EchocardiographyNuclearMyocardialPerfusionInvasiveCoronaryAngiography19以往的检查方式验血胆固醇血压的检查心电图检查侵入性冠状动脉血管造影术20跑步机测试特点：可达到60%-70%的准确度简单、易用然而：负值并不是指您没有患上心脏病的风险只可以诊断您的心血管没有超过70%的阻塞但仍有40%-60%阻塞的可能性21三维立体超声波心动扫描22NuclearMyocardialPerfusion23介入性冠状动脉血管造影术

的血管影像24侵入性冠状动脉血管造影术25磁共振MRI26磁共振的心脏影像27最新的检查方法

四维立体冠状动脉CT血管造影术28Limitationsofcurrentnon-invasivetestsindetectingblockedheartarteriesO’RourkeRAetal,metanalysisinAmericanCollegeofCardiology/AmericanHeartAssociationExpertConsensusDocumentonelectron-beamcomputedtomographyforthediagnosisandprognosisofcoronaryarterydisease.JAmCollCardiol.2000;36:326–340.29AuthorJournalYearMSCTSnSpPPVNPVPuglieseFetalEurRadiol.2006Mar6499967899FineJJetalAmJCardiol.2006Jan6495969792LimMetalClinicalRadiology2006Feb4099989499CordeiroMAetalHeart2005Oct3276947196MolletNRetalCirculation.2005Oct6499957699RaffGLetalJAmCollCardiol.2005Aug6486956698LeschkaSetalEurHeartJ.2005Aug6494978799RecentPublicationsusingMDCT30CoronaryArteryDisease

ComparisonbetweenMDCTandCoronaryAngiographyaAabbb31LumenPlaquePlaque“NormalAngiogram”byICAPlaquesdetectedbyCTAbutare“invisible”inICA32多功能电脑断层扫描仪

——精确度有多少？在影像分析方面的经验决定着CT扫描的准确程度资深的放射学医师通过对影像数据透彻的分析可使准确度提高我们中心能够提供98-99%的精确度33四维立体冠状动脉CT血管造影术

-适合哪类人群？患有多种慢性病的人群有严重家族史的人群有患心脏中风疾病风险的中年人群34心脏影像35心脏影像

36多功能CT扫描的优势无创伤性简单快速的检查程序门诊检查，无需住院清晰的心脏血管影像四维立体影像精确到以毫米计算较少的辐射无需开刀37CommonRiskFactors常见病因Extensiveclinicalandstatisticalstudieshaveidentifiedseveralfactorsthatincreasetheriskofstroke.Mostofthemcanbemodified,treatedorcontrolled.Somecan’t.

38HowCardiovascular&StrokeRisksAreRelated:

心脏病和中风为什么是相关联的

Bothcoronaryheartdiseaseandstrokesharemanyofthesameriskfactorssuchascholesteroldisorders,highbloodpressure,smoking,diabetes,physicalinactivity,andbeingoverweightorobese.3964排CT适应人群男性年龄大