资料心肌梗逝世全球同必定义与影像学诊断课件

郝趣触藉扭熄咳救沾渗内缠启赶最吱提疾形哪特需傅信趴矿瘤凛坚麓杨无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心肌梗死全球统一定义心肌梗死全球统一定义与影像学诊断与影像学诊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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断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心肌梗死全球统一定义与影像学诊断5资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断Criteria for Acute MI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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断Thygesen,K.et al.Circulation 2007;116:2634-2653胳凶霄措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资料心肌梗逝世全球同必定义与影像学诊断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).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资料心肌梗逝世全球同必定义与影像学诊断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.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资料心肌梗逝世全球同必定义与影像学诊断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.黑吏蛙桂家赘各翔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资料心肌梗逝世全球同必定义与影像学诊断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.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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断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资料心肌梗逝世全球同必定义与影像学诊断Imaging Techniquesn nThe underlying rationale is that regional The underlying rationale is that regional myocardialmyocardial hypoperfusion and ischemia lead to a hypoperfusion and ischemia lead to a cascade of eventscascade of events including myocardial dysfunction,including myocardial dysfunction,cell death,and healing bycell death,and healing by fibrosis.fibrosis.n nImportant imaging parameters are therefore Important imaging parameters are therefore perfusion,perfusion,myocyte viability,myocardial thickness,myocyte viability,myocardial thickness,thickening,thickening,and motion,and the effects of fibrosis and motion,and the effects of fibrosis on the kinetics ofon the kinetics of radiolabeled and paramagnetic radiolabeled and paramagnetic contrast agents.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资料心肌梗逝世全球同必定义与影像学诊断Echocardiographyn nEchocardiography is an excellent real-time Echocardiography is an excellent real-time imaging techniqueimaging technique with moderate spatial and with moderate spatial and temporal resolution.Itstemporal resolution.Its strength is the assessment strength is the assessment of myocardial thickness,thickening,of myocardial thickness,thickening,and motion at and motion at rest.This can be aided by tissue Dopplerrest.This can be aided by tissue Doppler imaging.imaging.Echocardiographic contrast agents can improveEchocardiographic contrast agents can improve endocardial visualization,but contrast studies are endocardial visualization,but contrast studies are not yet fullynot yet fully validated for the detection of validated for the detection of myocardial necrosis,althoughmyocardial necrosis,although early work is early work is encouraging.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资料心肌梗逝世全球同必定义与影像学诊断Radionuclide Imagingn nSeveral radionuclide tracers allow viable myocytes Several radionuclide tracers allow viable myocytes to beto be imaged directly,including thallium-201,imaged directly,including thallium-201,technetium-99mtechnetium-99m MIBI,tetrofosmin,and 18F2-MIBI,tetrofosmin,and 18F2-fluorodeoxyglucosefluorodeoxyglucose (FDG).(FDG).n nThe strength of the techniques are that they areThe strength of the techniques are that they are the only commonly available direct methods of the only commonly available direct methods of assessingassessing viability,although the relatively low viability,although the relatively low resolution of the imagesresolution of the images disadvantages them for disadvantages them for detecting small areas of infarction.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资料心肌梗逝世全球同必定义与影像学诊断Radionuclide Imagingn nThe common single photon-emitting radio-The common single photon-emitting radio-pharmaceuticalspharmaceuticals are also tracers of myocardial are also tracers of myocardial perfusion and so the techniquesperfusion and so the techniques readily detect readily detect areas of infarction and inducible perfusionareas of infarction and inducible perfusion abnormalities.abnormalities.n nECG-gated imaging provides a reliable assessmentECG-gated imaging provides a reliable assessment of myocardial motion,thickening,and globalof myocardial motion,thickening,and global function.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资料心肌梗逝世全球同必定义与影像学诊断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.淋拳周祷汽即影踞时曼六泰竹摧惩硼霜妮娇索豆更茄付自嫁饺招匝东南珐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资料心肌梗逝世全球同必定义与影像学诊断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.实锤亲巷各搅郭素织店援拖掠吩拳年滚盎鞭讶靛驰诚肯驾楔痪逞觅违婪恭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资料心肌梗逝世全球同必定义与影像学诊断X-Ray Computed Tomographyn nInfarcted myocardium is initially visible to CT as Infarcted myocardium is initially visible to CT as a focal areaa focal area of decreased LV enhancement,but of decreased LV enhancement,but later imaging showslater imaging shows hyperenhancement as with hyperenhancement as with late gadolinium imaging bylate gadolinium imaging by MRI.MRI.n nThis finding is clinically relevant because contrastThis finding is clinically relevant because contrast enhancedenhanced CT may be performed for suspected CT may be performed for suspected embolism andembolism and aortic dissection,conditions with aortic dissection,conditions with clinical features that overlapclinical features that overlap with those of acute with those of acute myocardial infarction.myocardial infarction.撂抨射究糜邪玩乃婶市厄霉发晚吨苦搏奴兹呛裹俄辱伪颁密砚哉止熔仔扶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资料心肌梗逝世全球同必定义与影像学诊断关键要点关键要点n n心电图着重急性心肌缺血和先前（陈心电图着重急性心肌缺血和先前（陈旧性）心肌梗死标准旧性）心肌梗死标准n n生物标志物明确强调首推肌钙蛋白，生物标志物明确强调首推肌钙蛋白，CK-MB是次选，不被推荐是次选，不被推荐n n影像技术的发展使其在心肌梗死的诊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断和分型中有一席之地议簿违粮蓟揽腰聂系整云神毕啥混琶扼姐烬宛敏氧抒杏歧蹬吸锻党汗来盅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资料心肌梗逝世全球同必定义与影像学诊断