1、64排螺旋CT在冠心病诊断上的应用张雅君主任医师ST.MICHAEL HOSPITAL,在新加坡。 在中国。,英年早逝震惊中国,河南17岁高中生两周前 突然出现心脏猝死，,没有任何迹象 没有胸部疼痛 发生在健康的人群中 在慢跑或长跑时 心脏病发作与突发性猝死 什么原因呢？。,如何控制心脏病的发生,如何预防冠心病的发生如何了解自己是否患有冠心病患有冠心病如何治疗健康活到100岁,传说 心脏病及中风只会发生在那些血管有严重阻塞的人身上 通常会发生在那些上了年纪的人群,事实,动脉血管的阻塞程度是由多年的累积所造成的大多数心脏病发作是由于血管壁的屯积物然破裂，血小板凝聚形成斑块而造成血管阻塞,Like
2、lihood of Plaque Rupture Does NOT correlate with the Severity of Coronary Artery Stenosis 冠状动脉狭窄的严重程度与血栓破裂没有关系,动脉粥样硬化,血管内皮损伤,胆固醇聚集,原因。,2/3 的心脏病突然发作是因为心脏血管只有40-60%的阻塞阻塞不严重时是没有明显症状的对那些心血管阻塞程度已经超过70%的病患更需要例行常规检查,Topics,Risk Factors of Heart Disease Latest Findings in Reducing Heart Disease Latest Advan
3、ces in Medical Technology in Preventing Heart Disease Conclusion,Risk factors for stroke that cant be changed: 不能改变的原因Age 年龄 Heredity (family history) 家族史 Prior stroke, TIA or heart attack 以前发生过中风，一过性脑缺血，心脏病,Risk factors that can be changed, treated or controlled:可控制的因素High blood pressure 高血压 Cigare
4、tte smoking 吸烟 Diabetes mellitus 糖尿病 Carotid or other artery disease 颈动脉和其他 血管疾病 Other heart disease 心脏病 High blood cholesterol 高血脂 Poor diet 不健康的饮食习惯 Physical inactivity and obesity 缺乏运动及肥胖,Main Cause of Heart Attack is Plaque ( Fat Deposit) Rupture,心肌梗塞,Evolution of NHLBI Supported Guidelines,Angi
5、ographic trials (FATS, POSCH, SCOR, STARS, Ornish, MARS) Meta-analyses (Holme, Rossouw),NCEP ATP I 1988,NCEP ATP II 1993,NCEP ATP III 2001,HPS PROVE-IT ASCOT-LLA PROSPER ALLHAT-LLT,Updated NCEP ATP III 2004,Framingham MRFIT LRC-CPPT Coronary Drug Project Helsinki Heart CLAS,4S WOSCOPS CARE LIPID AFC
6、APS/ TexCAPS,TNT IDEAL,AHA/ACC Update 2006,More Intensive Treatment Recommendations,NCEP ATP = National Cholesterol Education Panel Adult Treatment Panel. NHLBI = National Heart, Lung, and Blood Institute. AHA = American Heart Association. ACC = American College of Cardiology.,AHA/ACC guidelines for
7、 patients with CHD*,2 100 mg/dL: Goal for all patients with CHD,270 mg/dL: A reasonable goal for all patients with CHD,2,ATP III Update 20041 20%)170 mg/dL: Therapeutic option for very high-risk patients1,Intensive LDL-C Goals for High-Risk Patients,100 mg/dL,70 mg/dL,* And other forms of atheroscle
8、rotic disease.2 Factors that place a patient at very high risk: established cardiovascular disesase (CVD) plus:multiple major risk factors (especially diabetes); severe and poorly controlled risk factors (eg, cigarette smoking); metabolic syndrome (triglycerides TG 200 mg/dL + nonHDL-C 130 mg/dL wit
9、h HDL-C 40 mg/dL); and acute coronary syndromes.1 1. Grundy SM et al. Circulation. 2004;110:227239. 2. Smith SC Jr et al. Circulation, 2006; 113:23632372.,2006 Update,Recommended LDL-C treatment goals,If it is not possible to attain LDL-C 50% with more intensive LDL-Clowering therapy, including drug
10、 combinations.,Which Test Can Detect Heart Disease Early and Accurately 运用什么测试可以尽早的发现心脏病并得到精确的结论,METHODS OF DETECTION,Some examples:Electrocardiogram (ECG)EchocardiographyNuclear Myocardial PerfusionInvasive Coronary Angiography,以往的检查方式,验血 胆固醇 血压的检查 心电图检查 侵入性冠状动脉血管造影术,跑步机测试,特点： 可达到60%-70%的准确度 简单、易用然
11、而： 负值并不是指您没有患上心脏病的风险 只可以诊断您的心血管没有超过70%的阻塞 但仍有40%-60%阻塞的可能性,三维立体超声波心动扫描,Nuclear Myocardial Perfusion,介入性冠状动脉血管造影术 的血管影像,侵入性冠状动脉血管造影术,磁 共 振MRI,磁共振的心脏影像,最新的检查方法 四维立体冠状动脉CT血管造影术,Limitations of current non-invasive tests in detecting blocked heart arteries,ORourke RA et al , metanalysis in American Colle
12、ge of Cardiology/American Heart Association Expert Consensus Document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol. 2000;36:326 340.,Recent Publications using MDCT,Coronary Artery Disease Comparison between MDCT and Coronary Angio
13、graphy,a,A,a,b,b,Lumen,Plaque,Plaque,“Normal Angiogram” by ICA,Plaques detected by CTA but are “invisible” in ICA,多功能电脑断层扫描仪 精确度有多少？,在影像分析方面的经验决定着CT扫描的准确程度资深的放射学医师通过对影像数据透彻的分析可使准确度提高我们中心能够提供98-99%的精确度,四维立体冠状动脉CT血管造影术 - 适合哪类人群？,患有多种慢性病的人群有严重家族史的人群有患心脏中风疾病风险的中年人群,心脏影像,心脏影像,多功能CT扫描的优势,无创伤性 简单快速的检查程序 门诊
14、检查，无需住院 清晰的心脏血管影像 四维立体影像 精确到以毫米计算 较少的辐射 无需开刀,Common Risk Factors 常见病因Extensive clinical and statistical studies have identified several factors that increase the risk of stroke. Most of them can be modified, treated or controlled. Some cant.,How Cardiovascular & Stroke Risks Are Related: 心脏病和中风为什么是相
15、关联的Both coronary heart disease and stroke share many of the same risk factors such as cholesterol disorders, high blood pressure, smoking, diabetes, physical inactivity, and being overweight or obese.,64排CT适应人群,男性年龄大于40岁，女性年龄大于45岁 平时有胸闷，心悸，胸痛而心电图检查正常或者体检提示有心肌缺血的病人。 有肥胖症、高血压、高血脂、糖尿病的病人，应了解冠脉血管受损情况。 有冠心病家族史、平时性格过于孤癖、长期心理压力较大的人 已确诊冠心病的病人，治疗效果不佳，应进行64排螺旋CT检查详细了解冠脉病变。为下一步治疗提供依据。 冠状动脉支架术或搭桥术的病人随访，了解再狭窄的情况。,结论,尽早的检查及诊断可挽救生命血管斑块会从年轻时已经开始逐渐形成，所以更需要尽早检查即使您有血管狭窄的问题存在，及早治疗仍可以降低您患上心脏疾病的风险,
