心肌梗死全球统一定义与影像学诊断.pptxVIP

心肌梗死全球统一定义与影像学诊断第1页/共26页 心肌梗死全球统一定义与影像学诊断第2页/共26页 Thygesen, K. et al. Circulation 2007;116:2634-2653第3页/共26页 Criteria for Acute MI第4页/共26页 Criteria for Acute MI第5页/共26页 Criteria for Acute MI第6页/共26页 Criteria for Acute MI第7页/共26页 Criteria for Acute MI第8页/共26页 Criteria for Acute MI第9页/共26页 Criteria for Prior MI第10页/共26页 Thygesen, K. et al. Circulation 2007;116:2634-2653第11页/共26页 Biomarker EvaluationThe 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).第12页/共26页 Electrocardiographic Detection ofMyocardial InfarctionThe 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. 第13页/共26页 Electrocardiographic Detection ofMyocardial InfarctionCoronary 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.第14页/共26页 Electrocardiographic Detection ofMyocardial InfarctionThe 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.第15页/共26页 第16页/共26页 第17页/共26页 第18页/共26页 Imaging TechniquesThe underlying rationale is that regional myocardial hypoperfusion and ischemia lead to a cascade of events in