存活心肌检测及cto介入治疗侯玉清.ppt

侯玉清南方医科大学南方医院,存活心肌检测及CTO介入治疗,血管再通成功率再狭窄率再闭塞率能否改善预后有无存活心肌,CTO介入治疗关注焦点,1.冬眠心肌 2.顿抑心肌 3.坏死心肌 4.瘢 痕冬眠、顿抑心肌均属存活心肌，坏死心肌和瘢痕属于不可逆性心肌损害,存活心肌（Myocardial Viability）,存活心肌检测方法,1.心肌灌注显像(99mTc-MIBI)：多巴酚丁胺负荷 201铊(201Tl)：运动再分布再灌注201Tl心肌显像:2.超声心动图显像 多巴酚丁胺负荷超声心动图3.对比增强磁共振4.18FDG-PET 5.其它：CT灌注显像等。PET灌注及代谢显像金标准！,Negative stress echo before PCI,Apical 4 chamber view at rest,Apical 4 chamber view at peak stress,Positive stress echo before PCI,Apical 4 chamber view at rest,Apical 4 chamber view at peak stress,Positive stress echo before PCI,Apical 2 chamber view at rest,Apical 2 chamber view at peak stress,CASE:LAD-CTO,心肌代谢显像及心肌存活性评估,显像剂：18F-FDG或11C-软脂酸 方 法：血流+代谢诊断依据：,南方PET中心,1.正常显像（正常心肌）正常灌注 正常FDG代谢2.不匹配显像（存活心肌）灌注减少 FDG正常代谢3.匹配显像（坏死心肌）灌注缺损 代谢缺损,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 normally 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血流及代谢显像未见异常,冠心病，心梗，心肌存活,南方PET中心,血流显像,代谢显像,冠心病，前壁心梗，无存活心肌,南方PET中心,血流显像,代谢显像,存活心肌检测意义,1.左室功能（EF）是MI后长期预后的重要预测因素；2.冠脉严重狭窄/闭塞及EF低下者MACE事件及病死率较高：3.有存活心肌(冬眠及顿抑心肌17%)者通过血运重建可以改善左室功能并改变预后，4 持续严重缺血则导致心肌凋亡、坏死、纤维化，最终导致心功能衰竭。,J Nucl Med Technol 1999;27:93-102,CTO治疗的合理方式:临床病情存活心肌病变特征术者经验 决定,存活心肌检测及CTO介入治疗,总 结,Thank you!,