64排螺旋CT在冠心病診斷上的應(yīng)用

主任醫(yī)師

ST.MICHAELHOSPITAL1在新加坡。。。

在中國(guó)。。。英年早逝震驚中國(guó)

河南17歲高中生兩周前突然出現(xiàn)心臟猝死，2

沒有任何跡象

沒有胸部疼痛

發(fā)生在健康的人群中

在慢跑或長(zhǎng)跑時(shí)

心臟病發(fā)作與突發(fā)性猝死

什么原因呢？。。。

3如何控制心臟病的發(fā)生如何預(yù)防冠心病的發(fā)生如何了解自己是否患有冠心病患有冠心病如何治療健康活到100歲4傳說

心臟病及中風(fēng)只會(huì)發(fā)生在那些血管有嚴(yán)重阻塞的人身上

通常會(huì)發(fā)生在那些上了年紀(jì)的人群

5事實(shí)動(dòng)脈血管的阻塞程度是由多年的累積所造成的大多數(shù)心臟病發(fā)作是由于血管壁的屯積物然破裂，血小板凝聚形成斑塊而造成血管阻塞6LikelihoodofPlaqueRuptureDoesNOTcorrelatewiththeSeverityofCoronaryArteryStenosis冠狀動(dòng)脈狹窄的嚴(yán)重程度與血栓破裂沒有關(guān)系7動(dòng)脈粥樣硬化管腔變窄血栓形成正常血管血管內(nèi)皮損傷膽固醇聚集8原因。。。2/3的心臟病突然發(fā)作是因?yàn)樾呐K血管只有40-60%的阻塞阻塞不嚴(yán)重時(shí)是沒有明顯癥狀的對(duì)那些心血管阻塞程度已經(jīng)超過70%的病患更需要例行常規(guī)檢查9TopicsRiskFactorsofHeartDiseaseLatestFindingsinReducingHeartDiseaseLatestAdvancesinMedicalTechnologyinPreventingHeartDiseaseConclusion10Riskfactorsforstrokethatcan'tbechanged:不能改變的原因Age

年齡Heredity(familyhistory)

家族史Priorstroke,TIAorheartattack

以前發(fā)生過中風(fēng)，一過性腦缺血，心臟病11Riskfactorsthatcanbechanged,treatedorcontrolled:可控制的因素Highbloodpressure

高血壓Cigarettesmoking

吸煙Diabetesmellitus

糖尿病Carotidorotherarterydisease

頸動(dòng)脈和其他血管疾病Otherheartdisease

心臟病Highbloodcholesterol

高血脂Poordiet

不健康的飲食習(xí)慣Physicalinactivityandobesity

缺乏運(yùn)動(dòng)及肥胖12MainCauseofHeartAttackisPlaque(FatDeposit)Rupture13心肌梗塞14EvolutionofNHLBISupportedGuidelinesAngiographictrials(FATS,POSCH,SCOR,STARS,Ornish,MARS)Meta-analyses

(Holme,Rossouw)NCEPATPI1988NCEPATPII1993NCEPATPIII2001HPS

PROVE-ITASCOT-LLAPROSPERALLHAT-LLTUpdatedNCEPATPIII2004Framingham

MRFIT

LRC-CPPT

Coronary

DrugProject

HelsinkiHeart

CLAS4S

WOSCOPS

CARE

LIPID

AFCAPS/

TexCAPSTNTIDEALAHA/ACCUpdate2006MoreIntensiveTreatmentRecommendationsNCEPATP=NationalCholesterolEducationPanelAdultTreatmentPanel.NHLBI=NationalHeart,Lung,andBloodInstitute.AHA=AmericanHeartAssociation.ACC=AmericanCollegeofCardiology.15AHA/ACCguidelinesforpatientswithCHD*,2<100mg/dL:GoalforallpatientswithCHD?,2<70mg/dL:AreasonablegoalforallpatientswithCHD?,2ATPIIIUpdate20041<100mg/dL:PatientswithCHDorCHDriskequivalents(10-yearrisk>20%)1<70mg/dL:Therapeuticoptionforveryhigh-riskpatients1IntensiveLDL-CGoalsfor

High-RiskPatients<100mg/dL<70mg/dL* Andotherformsofatheroscleroticdisease.2? Factorsthatplaceapatientatveryhighrisk:establishedcardiovasculardisesase(CVD)plus: multiplemajorriskfactors(especiallydiabetes);severeandpoorlycontrolledriskfactors(eg,cigarettesmoking);metabolicsyndrome(triglycerides[TG]≥200mg/dL+non–HDL-C≥130mg/dLwithHDL-C<40mg/dL);andacutecoronarysyndromes.11.GrundySMetal.Circulation.2004;110:227–239.2.SmithSCJretal.Circulation,2006;113:2363–2372.2006

UpdateRecommendedLDL-CtreatmentgoalsIfitisnotpossibletoattainLDL-C<70mg/dLbecauseofahighbaselineLDL-C,itgenerallyispossibletoachieveLDL-Creductionsof>50%withmoreintensiveLDL-C─loweringtherapy,includingdrugcombinations.1617WhichTestCan

DetectHeartDisease

EarlyandAccurately運(yùn)用什么測(cè)試可以盡早的發(fā)現(xiàn)心臟病并得到精確的結(jié)論18METHODSOFDETECTIONSomeexamples:Electrocardiogram(ECG)EchocardiographyNuclearMyocardialPerfusionInvasiveCoronaryAngiography19以往的檢查方式驗(yàn)血膽固醇血壓的檢查心電圖檢查侵入性冠狀動(dòng)脈血管造影術(shù)20跑步機(jī)測(cè)試特點(diǎn)：可達(dá)到60%-70%的準(zhǔn)確度簡(jiǎn)單、易用然而：負(fù)值并不是指您沒有患上心臟病的風(fēng)險(xiǎn)只可以診斷您的心血管沒有超過70%的阻塞但仍有40%-60%阻塞的可能性21三維立體超聲波心動(dòng)掃描22NuclearMyocardialPerfusion23介入性冠狀動(dòng)脈血管造影術(shù)

的血管影像24侵入性冠狀動(dòng)脈血管造影術(shù)25磁共振MRI26磁共振的心臟影像27最新的檢查方法

四維立體冠狀動(dòng)脈CT血管造影術(shù)28Limitationsofcurrentnon-invasivetestsindetectingblockedheartarteriesO’RourkeRAetal,metanalysisinAmericanCollegeofCardiology/AmericanHeartAssociationExpertConsensusDocumentonelectron-beamcomputedtomographyforthediagnosisandprognosisofcoronaryarterydisease.JAmCollCardiol.2000;36:326–340.29AuthorJournalYearMSCTSnSpPPVNPVPuglieseFetalEurRadiol.2006Mar6499967899FineJJetalAmJCardiol.2006Jan6495969792LimMetalClinicalRadiology2006Feb4099989499CordeiroMAetalHeart2005Oct3276947196MolletNRetalCirculation.2005Oct6499957699RaffGLetalJAmCollCardiol.2005Aug6486956698LeschkaSetalEurHeartJ.2005Aug6494978799RecentPublicationsusingMDCT30CoronaryArteryDisease

ComparisonbetweenMDCTandCoronaryAngiographyaAabbb31LumenPlaquePlaque“NormalAngiogram”byICAPlaquesdetectedbyCTAbutare“invisible”inICA32多功能電腦斷層掃描儀

——精確度有多少？在影像分析方面的經(jīng)驗(yàn)決定著CT掃描的準(zhǔn)確程度資深的放射學(xué)醫(yī)師通過對(duì)影像數(shù)據(jù)透徹的分析可使準(zhǔn)確度提高我們中心能夠提供98-99%的精確度33四維立體冠狀動(dòng)脈CT血管造影術(shù)

-適合哪類人群？患有多種慢性病的人群有嚴(yán)重家族史的人群有患心臟中風(fēng)疾病風(fēng)險(xiǎn)的中年人群34心臟影像35心臟影像

36多功能CT掃描的優(yōu)勢(shì)無創(chuàng)傷性簡(jiǎn)單快速的檢查程序門診檢查，無需住院清晰的心臟血管影像四維立體影像精確到以毫米計(jì)算較少的輻射無需開刀37CommonRiskFactors常見病因Extensiveclinicalandstatisticalstudieshaveidentifiedseveralfactorsthatincreasetheriskofstroke.Mostofthemcanbemodified,treatedorcontrolled.Somecan’t.

38HowCardiovascular&StrokeRisksAreRelated:

心臟病和中風(fēng)為什么是相關(guān)聯(lián)的

Bothcoronaryheartdiseaseandstrokesharemanyofthesameriskfactorssuchascholesteroldisorders,highbloodpressure,smoking,diabetes,physicalinactivity,andbeingoverweightorobese.3964排CT適應(yīng)人群男性年齡大