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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Thygesen,K.etal.Circulation2007;116:2634-2653CriteriaforAcuteMICriteriaforAcuteMICriteriaforAcuteMICriteriaforAcuteMICriteriaforAcuteMICriteriaforAcuteMICriteriaforPriorMIThygesen,K.etal.Circulation2007;116:2634-2653Bioma
2、rkerEvaluationThepreferredbiomarkerformyocardialnecrosisiscardiactroponin(IorT),whichhasnearlyabsolutemyocardialtissuespecificityaswellashighclinicalsensitivity,therebyreflectingevenmicroscopiczonesofmyocardialnecrosis.Iftroponinassaysarenotavailable,theb
3、estalternativeisCKMB(measuredbymassassay).ElectrocardiographicDetectionof MyocardialInfarctionTheECGisanintegralpartofthediagnosticwork-upofpatientswithsuspectedmyocardialinfarction.TheacuteorevolvingchangesintheST-TwaveformsandtheQ-waveswhenpresentpotent
4、iallyallowthecliniciantodatetheevent,tosuggesttheinfarct-relatedartery,andtoestimatetheamountofmyocardiumatrisk.ElectrocardiographicDetectionof MyocardialInfarctionCoronaryarterydominance,sizeanddistributionofarterialsegments,collateralvessels,andlocation
5、,extent,andseverityofcoronarystenosescanalsoimpactECGmanifestationsofmyocardialischemia.ElectrocardiographicDetectionof MyocardialInfarctionTheECGbyitselfisofteninsufficienttodiagnoseacutemyocardialischemiaorinfarctionsinceSTdeviationmaybeobservedinotherc
6、onditionssuchasacutepericarditis,LVhypertrophy,LBBB,Brugadasyndrome,andearlyrepolarizationpatterns.AlsoQ-wavesmayoccurduetomyocardialfibrosisintheabsenceofcoronaryarterydisease,asin,forexample,cardiomyopathy.ImagingTechniquesTheunderlyingrationaleisthatre
7、gionalmyocardialhypoperfusionandischemialeadtoacascadeofeventsincludingmyocardialdysfunction,celldeath,andhealingbyfibrosis.Importantimagingparametersarethereforeperfusion,myocyteviability,myocardialthickness,thickening,andmotion,andtheeffectsoffibrosison
8、thekineticsofradiolabeledandparamagneticcontrastagents.EchocardiographyEchocardiographyisanexcellentreal-timeimagingtechniquewithmoderatespatialandtemporalresolution.Itsstrengthistheassessmentofmyocardialthickness,t
