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 1 Thygesen K etal Circulation2007 116 2634 2653 2 CriteriaforAcuteMI 3 CriteriaforAcuteMI 4 CriteriaforAcuteMI 5 CriteriaforAcuteMI 6 CriteriaforAcuteMI 7 CriteriaforAcuteMI 8 CriteriaforPriorMI 9 Thygesen K etal Circulation2007 116 2634 2653 10 BiomarkerEvaluation Thepreferredbiomarkerformyocardialnecrosisiscardiactroponin IorT whichhasnearlyabsolutemyocardialtissuespecificityaswellashighclinicalsensitivity therebyreflectingevenmicroscopiczonesofmyocardialnecrosis Iftroponinassaysarenotavailable thebestalternativeisCKMB measuredbymassassay 11 ElectrocardiographicDetectionofMyocardialInfarction TheECGisanintegralpartofthediagnosticwork upofpatientswithsuspectedmyocardialinfarction TheacuteorevolvingchangesintheST TwaveformsandtheQ waveswhenpresentpotentiallyallowthecliniciantodatetheevent tosuggesttheinfarct relatedartery andtoestimatetheamountofmyocardiumatrisk 12 ElectrocardiographicDetectionofMyocardialInfarction Coronaryarterydominance sizeanddistributionofarterialsegments collateralvessels andlocation extent andseverityofcoronarystenosescanalsoimpactECGmanifestationsofmyocardialischemia 13 ElectrocardiographicDetectionofMyocardialInfarction TheECGbyitselfisofteninsufficienttodiagnoseacutemyocardialischemiaorinfarctionsinceSTdeviationmaybeobservedinotherconditionssuchasacutepericarditis LVhypertrophy LBBB Brugadasyndrome andearlyrepolarizationpatterns AlsoQ wavesmayoccurduetomyocardialfibrosisintheabsenceofcoronaryarterydisease asin forexample cardiomyopathy 14 15 16 17 ImagingTechniques Theunderlyingrationaleisthatregionalmyocardialhypoperfusionandischemialeadtoacascadeofeventsincludingmyocardialdysfunction celldeath andhealingbyfibrosis Importantimagingparametersarethereforeperfusion myocyteviability myocardialthickness thickening andmotion andtheeffectsoffibrosisonthekineticsofradiolabeledandparamagneticcontrastagents 18 Echocardiography Echocardiographyisanexcellentreal timeimagingtechniquewithmoderatespatialandtemporalresolution Itsstrengthistheassessmentofmyocardialthickness thickening andmotionatrest ThiscanbeaidedbytissueDopplerimaging Echocardiographiccontrastagentscanimproveendocardialvisualization butcontraststudiesarenotyetfullyvalidatedforthedetectionofmyocardialnecrosis althoughearlyworkisencouraging 19 RadionuclideImaging Severalradionuclidetracersallowviablemyocytestobeimageddirectly includingthallium 201 technetium 99mMIBI tetrofosmin and 18F 2 fluorodeoxyglucose FDG Thestrengthofthetechniquesarethattheyaretheonlycommonlyavailabledirectmethodsofassessingviability althoughtherelativelylowresolutionoftheimagesdisadvantagesthemfordetectingsmallareasofinfarction 20 RadionuclideImaging Thecommonsinglephoton emittingradio pharmaceuticalsarealsotracersofmyocardialperfusionandsothetechniquesreadilydetectareasofinfarctionandinducibleperfusionabnormalities ECG gatedimagingprovidesareliableassessmentofmyocardialmotion thickening andglobalfunction 21 MagneticResonanceImaging CardiovascularMRIhashighspatialresolutionandmoderatetemporalresolution Itisawell validatedstandardfortheassessmentofmyocardialfunctionandhas intheory similarcapabilitytoechocardiographyinsuspectedacuteinfarction Itis however morecumbersomeinanacutesettingandisnotcommonlyused 22 MagneticResonanceImaging Paramagneticcontrastagentscanbeusedtoassessmyocardialperfusionandtheincreaseinextracellularspaceassociatedwiththefibrosisofchronicinfarction Theformerisnotyetfullyvalidatedinclinicalpractice butthelatteriswellvalidatedandcanplayanimportantroleinthedetectionofinfarction 23 X RayComputedTomography InfarctedmyocardiumisinitiallyvisibletoCTasafocalareaofdecreasedLVenhancement butlaterimagingshowshyperenhancementaswithlategadoliniumimagingbyMRI ThisfindingisclinicallyrelevantbecausecontrastenhancedCTmaybeperformedforsuspectedembolismandaorticdissection conditionswithclinicalfeaturesthatoverlapwiththoseofacutemyocardialinfarction 24 关键要点 心电图着重急性心肌缺血和先前 陈旧性 心肌梗死标准生物标志物明确强调首推肌钙蛋白 CK MB是次选 不被推荐影像技术的发展使其在心肌梗死的诊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 感谢您的观看和下载 Theusercandemonstrateonaprojectororcomputer orprintthepresentationandmakeitintoafilmtobeusedinawiderfield 29