心肌梗死全球统一定义与影像学诊断(1)ppt课件.ppt

心肌梗死全球心肌梗死全球统一定一定义与影像学与影像学诊断断何作祥何作祥中国医学科学院阜外心血管病医院中国医学科学院阜外心血管病医院1.Thygesen,K.et al.Circulation 2007;116:2634-26532.Criteria for Acute MI3.Criteria for Acute MI4.Criteria for Acute MI5.Criteria for Acute MI6.Criteria for Acute MI7.Criteria for Acute MI8.Criteria for Prior MI9.Thygesen,K.et al.Circulation 2007;116:2634-265310.Biomarker Evaluationn nThe preferred biomarker for myocardial necrosis is cardiac troponin(I or T),which has nearly absolute myocardial tissue specificity as well as high clinical sensitivity,thereby reflecting even microscopic zones of myocardial necrosis.n nIf troponin assays are not available,the best alternative is CKMB(measured by mass assay).11.Electrocardiographic Detection ofMyocardial Infarctionn nThe ECG is an integral part of the diagnostic work-up of patients with suspected myocardial infarction.n nThe acute or evolving changes in the ST-T waveforms and the Q-waves when present potentially allow the clinician to date the event,to suggest the infarct-related artery,and to estimate the amount of myocardium at risk.12.Electrocardiographic Detection ofMyocardial Infarctionn nCoronary artery dominance,size and distribution of arterial segments,collateral vessels,and location,extent,and severity of coronary stenoses can also impact ECG manifestations of myocardial ischemia.13.Electrocardiographic Detection ofMyocardial Infarctionn nThe ECG by itself is often insufficient to diagnose acute myocardial ischemia or infarction since ST deviation may be observed in other conditions such as acute pericarditis,LV hypertrophy,LBBB,Brugada syndrome,and early repolarization patterns.Also Q-waves may occur due to myocardial fibrosis in the absence of coronary artery disease,as in,for example,cardiomyopathy.14.15.16.17.Imaging Techniquesn nThe underlying rationale is that regional myocardial The underlying rationale is that regional myocardial hypoperfusion and ischemia lead to a cascade of hypoperfusion and ischemia lead to a cascade of events including myocardial dysfunction,cell death,events including myocardial dysfunction,cell death,and healing by fibrosis.and healing by fibrosis.n nImportant imaging parameters are therefore Important imaging parameters are therefore perfusion,myocyte viability,myocardial thickness,perfusion,myocyte viability,myocardial thickness,thickening,and motion,and the effects of fibrosis thickening,and motion,and the effects of fibrosis on the kinetics of radiolabeled and paramagnetic on the kinetics of radiolabeled and paramagnetic contrast agents.contrast agents.18.Echocardiographyn nEchocardiography is an excellent real-time Echocardiography is an excellent real-time imaging technique with moderate spatial and imaging technique with moderate spatial and temporal resolution.Its strength is the assessment temporal resolution.Its strength is the assessment of myocardial thickness,thickening,and motion at of myocardial thickness,thickening,and motion at rest.This can be aided by tissue Doppler imaging.rest.This can be aided by tissue Doppler imaging.Echocardiographic contrast agents can improve Echocardiographic contrast agents can improve endocardial visualization,but contrast studies are endocardial visualization,but contrast studies are not yet fully validated for the detection of not yet fully validated for the detection of myocardial necrosis,although early work is myocardial necrosis,although early work is encouraging.encouraging.19.Radionuclide Imagingn nSeveral radionuclide tracers allow viable myocytes Several radionuclide tracers allow viable myocytes to be imaged directly,including thallium-201,to be imaged directly,including thallium-201,technetium-99m MIBI,tetrofosmin,and 18F2-technetium-99m MIBI,tetrofosmin,and 18F2-fluorodeoxyglucose(FDG).fluorodeoxyglucose(FDG).n nThe strength of the techniques are that they are the The strength of the techniques are that they are the only commonly available direct methods of only commonly available direct methods of assessing viability,although the relatively low assessing viability,although the relatively low resolution of the images disadvantages them for resolution of the images disadvantages them for detecting small areas of infarction.detecting small areas of infarction.20.Radionuclide Imagingn nThe common single photon-emitting radio-The common single photon-emitting radio-pharmaceuticals are also tracers of myocardial pharmaceuticals are also tracers of myocardial perfusion and so the techniques readily detect perfusion and so the techniques readily detect areas of infarction and inducible perfusion areas of infarction and inducible perfusion abnormalities.abnormalities.n nECG-gated imaging provides a reliable assessment ECG-gated imaging provides a reliable assessment of myocardial motion,thickening,and global of myocardial motion,thickening,and global function.function.21.Magnetic Resonance Imagingn nCardiovascular MRI has high spatial resolution and moderate temporal resolution.It is a well-validated standard for the assessment of myocardial function and has,in theory,similar capability to echocardiography in suspected acute infarction.It is,however,more cumbersome in an acute setting and is not commonly used.22.Magnetic Resonance Imagingn nParamagnetic contrast agents can be used to assess myocardial perfusion and the increase in extracellular space associated with the fibrosis of chronic infarction.The former is not yet fully validated in clinical practice,but the latter is well validated and can play an important role in the detection of infarction.23.X-Ray Computed Tomographyn nInfarcted myocardium is initially visible to CT as a Infarcted myocardium is initially visible to CT as a focal area of decreased LV enhancement,but later focal area of decreased LV enhancement,but later imaging shows hyperenhancement as with late imaging shows hyperenhancement as with late gadolinium imaging by MRI.gadolinium imaging by MRI.n nThis finding is clinically relevant because contrast This finding is clinically relevant because contrast enhanced CT may be performed for suspected enhanced CT may be performed for suspected embolism and aortic dissection,conditions with embolism and aortic dissection,conditions with clinical features that overlap with those of acute clinical features that overlap with those of acute myocardial infarction.myocardial infarction.24.关关键要点要点n n心心电图着重急性心肌缺血和先前（着重急性心肌缺血和先前（陈旧性）心肌梗死旧性）心肌梗死标准准n n生物生物标志物明确志物明确强调首推肌首推肌钙蛋白，蛋白，CK-MB是次是次选，不被推荐，不被推荐n n影像技影像技术的的发展使其在心肌梗死的展使其在心肌梗死的诊断和分型中有一席之地断和分型中有一席之地25.后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用26.主要经营：网络软件设计、图文设计制作、发布广告等公司秉着以优质的服务对待每一位客户，做到让客户满意！27.致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求28.感感谢您的您的观看和下看和下载The user can demonstrate on a projector or computer,or print the presentation and make it into a film to be used in a wider field29.