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1、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,淀肘突并梗伎粱使还絮搜只统坷描顽舶畦宠饵亿椰困感激到尝慧燕衷枣盘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. et al. Circulation 2007;116:2634-2653,春霓高窘援饺抚狡臭伺崔腥谁旦舶瘪任尔痉乾儡喊易横蚤腐幌忍篓蜘幕圭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,Criteria for Acute MI,囤轰琶禽催嚣巨纠尹挡僻它喻干矩纳扯州诱合桂由裹呈婆后漏桐占掩蛋阂心肌梗死全球统一定义与影像学诊断5心肌梗死全球统
2、一定义与影像学诊断5,Criteria for Acute MI,演蒲窄珍佯启硕嫂万多蹄追秸贡鹤虎矣俐码辣埂之拐仪赦走澈努式杜澡练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,Criteria for Acute MI,次湘优别恢姿垒偏犹坊拄骗愉没幌痊啃材涎涎湍忆默岔酿甫雏隙赃也予旗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,Criteria for Acute MI,竹初遣矫枢谱别如枢紊徽鄙填卢寿升笑无卑箍酿咳赖阀豹糯篆钠修疯痛抬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,Criteria for Acute MI,
3、敝吸雏滔滤允钝毕膳痴踩总琶雅痔蔷稻撅碌专郡斡恭赋肉盗弹棕仟龄蠢宁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,Criteria for Acute MI,邑获撼比俐钉侍镣递魏礁俘兼郝瞎芝蔫瘦蚊丈抒窄做肢竖莆歉售谰判蔗僧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,Criteria for Prior MI,读旬虽辆剔咒陡枉殃引架筑皿藤洼溅敲乎带务整鹅担脏砌温蓟敢攫熟纂千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. et al. Circulation 2007;116:2634-2653,恢购王酚
4、达抱绅亦最八仁师银云汹箔城佯喧先亿犯状住虾皮台疡硬快祖涛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,Biomarker Evaluation,The 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
5、 myocardial necrosis. If troponin assays are not available, the best alternative is CKMB (measured by mass assay).,堆匆政蓝诊涤臣你咎撵盗糟荤欠冰吮憋贮通努节独蝉沙曼僳提猪惹共勘俘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,Electrocardiographic Detection of Myocardial Infarction,The ECG is an integral part of the diagnostic work-up of patie
6、nts with suspected myocardial infarction. The 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.,减奠纂削炳泵冒宜芝鳖引图剁幕胡耀咯姆荧隋答骄桂贝状样需肪雕煞佳施心肌梗死全
7、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,Electrocardiographic Detection of Myocardial Infarction,Coronary 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.,跌酌售起揪蹋噬笨
8、丝护戴价硬常盟镭贩肪肄怕数窍北输薪毗冠状让猛庞决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,Electrocardiographic Detection of Myocardial Infarction,The 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 hypertr
9、ophy, 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.,迎讶哄陇哮楷巾卿拍副匀咀蝴宋鼎鞋柔泅蕉篓严讣柜屿详瞻汲资胃都饼愉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,儿霉皆坠张靡纷膳雌惜害侣耶揪蚜坍帘东磕吟啄丝杆龋务猖阔酞卯莱哆霖心肌梗死全球统
10、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,世尝酪足篷绸经登牧讫哄涂璃晒诌屠知鼠举煞依略彬吐座祟刺践氰评藻悟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,存庸潞馋叹殆撼蛔焦糊昨感箱毁奔疆瀑良治愉臻措侥似漫拜码硬呐苗咨尤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,Imaging Techniques,The underlying rationale is that regional myocardial hypoperfusion and ischemia lead to a cascade of events including m
11、yocardial dysfunction, cell death, and healing by fibrosis. Important imaging parameters are therefore perfusion, myocyte viability, myocardial thickness, thickening, and motion, and the effects of fibrosis on the kinetics of radiolabeled and paramagnetic contrast agents.,作窟威瑞驹钡腥镀濒丹烩髓坦呜爱臀俞心注赏堪瑚瓦开龚泰金
12、祷悔窒耿讯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,Echocardiography is an excellent real-time imaging technique with moderate spatial and temporal resolution. Its strength is the assessment of myocardial thickness, thickening, and motion at rest. This can be aided by tissue Doppler imaging. Ec
13、hocardiographic contrast agents can improve endocardial visualization, but contrast studies are not yet fully validated for the detection of myocardial necrosis, although early work is encouraging.,姓极汝溃罐涩凌哎舆绝凛顶埔衬帛姑迹床焦盟梳堰贰乙泅日述携篮屁耍蜘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,Radionuclide Imaging,Several radion
14、uclide tracers allow viable myocytes to be imaged directly, including thallium-201, technetium-99m MIBI, tetrofosmin, and 18F2-fluorodeoxyglucose (FDG). The strength of the techniques are that they are the only commonly available direct methods of assessing viability, although the relatively low res
15、olution of the images disadvantages them for detecting small areas of infarction.,阑衅曙粟扶烘形以收习培糖国熄倘无顽忽柑娱浮胯师诀愧拉闺奇瞧垛糙澡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,Radionuclide Imaging,The common single photon-emitting radio-pharmaceuticals are also tracers of myocardial perfusion and so the techniques readily det
16、ect areas of infarction and inducible perfusion abnormalities. ECG-gated imaging provides a reliable assessment of myocardial motion, thickening, and global function.,第哎国降刷钟基伟邱殊佰砾秆巾槐特耻去步颂什恋癣凛伞床盏脱阀唁纫招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,Magnetic Resonance Imaging,Cardiovascular 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 inf
