心肌梗塞的病理生理学和诊断途径与非阻塞性冠状动脉
Jun Takahashi1, Sho Onuma1, Kiyotaka Hao1
1Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Journal of cardiology
|July 31, 2023
概括
心肌梗塞与非阻塞性冠状动脉 (MINOCA) 是一个多样化的疾病. 使用心脏磁共振 (CMR) 和光连贯断层扫描 (OCT) 的多模式方法有助于诊断MINOCA并确定其原因.
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 不阻塞冠状动脉的心肌梗塞 (MINOCA) 约占急性心肌梗塞 (AMI) 病例的6%.
- 当患有胸痛和升的热素患者在血管学上没有显著的冠状动脉狭窄时,就诊断出MINOCA.
- 最近的指导方针提倡MINOCA的多模式诊断方法.
研究的目的:
- 审查目前对MINOCA的理解.
- 为突出当代诊断策略可疑的MINOCA.
- 强调先进成像在MINOCA诊断中的作用.
主要方法:
- 关于MINOCA诊断和管理的当前文献的审查.
- 讨论心磁共振 (CMR) 在诊断MINOCA和排除模仿者的实用性.
- 强调冠状动脉内成像,特别是光学连贯断层扫描 (OCT),用于检测微妙的冠状动脉异常.
主要成果:
- 结合CMR和OCT的方法可以在显著比例的MINOCA患者中确立最终诊断.
- 对于区分MINOCA与非缺血性疾病,如 takotsubo心肌病和心肌炎,CMR非常有价值.
- OCT可以识别冠状动脉内病理,如斑块破坏和冠状动脉自发解剖,这些在血管图上是看不见的.
结论:
- 诊断MINOCA需要一个全面的战略超越传统的血管学.
- 像CMR和OCT这样的先进成像模式对于阐明MINOCA的潜在原因至关重要.
- 需要进一步的研究,以解决MINOCA的二次预防和长期预后方面的知识差距.
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