精品心肌梗死全球统一定义与影像学诊断课件.ppt

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 Criteria for Acute MI Criteria for Acute MI Criteria for Acute MI Criteria for Acute MI Criteria for Acute MI Criteria for Acute MI Criteria for Prior MI 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 myocardial necrosis. If troponin assays are not available, the best alternative is CKMB (measured by mass assay). Electrocardiographic Detection ofMyocardial Infarction The ECG is an integral part of the diagnostic work-up of patients 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. Electrocardiographic Detection ofMyocardial 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. Electrocardiographic Detection ofMyocardial 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 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. Imaging Techniques The underlying rationale is that regional myocardial hypoperfusion and ischemia lead to a cascade of events including myocardial 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