存活心肌檢測(cè)及cto介入治療_課件

1、侯玉清南方醫(yī)科大學(xué)南方醫(yī)院存活心肌檢測(cè)及CTO介入治療血管再通成功率再狹窄率再閉塞率能否改善預(yù)后有無存活心肌CTO介入治療關(guān)注焦點(diǎn) 1.冬眠心肌 2.頓抑心肌 3.壞死心肌 4.瘢 痕冬眠、頓抑心肌均屬存活心肌，壞死心肌和瘢痕屬于不可逆性心肌損害存活心?。∕yocardial Viability） 存活心肌檢測(cè)方法1.心肌灌注顯像 (99mTc-MIBI)：多巴酚丁胺負(fù)荷 201鉈(201Tl)：運(yùn)動(dòng)再分布再灌注201Tl心肌顯像:2.超聲心動(dòng)圖顯像 多巴酚丁胺負(fù)荷超聲心動(dòng)圖3.對(duì)比增強(qiáng)磁共振4.18FDG-PET 5.其它：CT灌注顯像等。PET灌注及代謝顯像金標(biāo)準(zhǔn)！Negative str

2、ess echo before PCIApical 4 chamber view at rest Apical 4 chamber view at peak stressPositive stress echo before PCIApical 4 chamber view at rest Apical 4 chamber view at peak stressPositive stress echo before PCIApical 2 chamber view at rest Apical 2 chamber view at peak stressCASE:LAD-CTO心肌代謝顯像及心肌

3、存活性評(píng)估顯像劑： 18F-FDG或11C-軟脂酸 方 法： 血流+代謝診斷依據(jù)：南方PET中心1.正常顯像（正常心?。?正常灌注 正常FDG代謝2.不匹配顯像（存活心?。?灌注減少 FDG正常代謝3.匹配顯像（壞死心肌） 灌注缺損 代謝缺損 Normal Study:Left Ventricle of myocardium. The myocardial wall is represented as a ring. This image shows normal blood flow and normal metabolic activity. Thus, this is a normall

4、y functioning myocardium.Mismatched Study:This image shows a decrease in blood flow and an increase in metabolism.This image shows a decrease in both blood flow and metabolism.Matched Study:PET血流及代謝顯像未見異常冠心病，心梗，心肌存活南方PET中心血流顯像代謝顯像冠心病，前壁心梗，無存活心肌南方PET中心血流顯像代謝顯像 存活心肌檢測(cè)意義1.左室功能（EF）是MI后長期預(yù)后的重要預(yù)測(cè)因素；2.冠脈嚴(yán)重狹窄/閉塞及EF低下者M(jìn)ACE事件及病死率較高：3.有存活心肌(冬眠及頓抑心肌17%)者通過血運(yùn)重建可以改善左室功能并改變預(yù)后，4 持續(xù)嚴(yán)重缺血?jiǎng)t導(dǎo)致心肌凋亡、壞死、纖維化，最終導(dǎo)致心功能衰竭。 J Nucl Med Technol 19