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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,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. et al. Circulation 2007;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,Criteria for Acute MI,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
2、一定义与影像学诊断5,Criteria for Acute MI,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,Criteria for Acute MI,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,Criteria for Acute MI,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,Criteria for Acute MI,
3、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,Criteria for Acute MI,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,Criteria for Prior MI,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. et al. Circulation 2007;116:2634-2653,胳凶霄措
4、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,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).,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,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.,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
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.,黑吏蛙桂家赘各翔
8、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,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.,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
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,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,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.,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
12、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,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.,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,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.,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,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.,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,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
