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缺血性心肌病的血管重建治疗 PowerPoint PPT Presentation


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缺血性心肌病的血管重建治疗. 贾国良. 第四军医大学西京医院心脏内科. 缺血性心肌病是由冠状动脉粥样硬化或机化导致的心肌弥漫性瘢痕及纤维化,临床上酷似扩张型心肌病的一组症候群。. 缺血性心肌病患者,其生存时间比非缺血性心衰短,广泛的冠状动脉病变是其生存期缩短的独立因素 。 LVEF≤0.35 ~ 0.4 的冠心病患者药物治疗,四年存活率仅为 35% ~ 60% 。. CABG. 1 .存活率及影响因素

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缺血性心肌病的血管重建治疗

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LVEF0.350.435%60%


CABG

1

Sao Paulo 71EF< 30%CABG2.8%562.8%


  • 1) Q

  • 2) Tl-201

  • 3) LVEF

  • 4)

    1 NYHA IV

    2) (LBBB)


CABG5NYHA IV LBBB


2

1991-11998-6 167CABG1594% +/- 2% 75% + /-10%


2.7 +/- 2.1(0.3-7.8)54%1598% +/- 1% 81% +/- 8%1578% +/- 11% 47% +/- 20%


LVEF< 30%


NYHA


3

49CABGA19CABGB30212



A321RVEF(LVEDD)(RVEF)


CABGRVEFCABG


5

26CABG201Tl18F2665722%62(23%)14756%314



61%3149%1431%31461%


PTCA

1PTCA

19871991100LVEF35% (0.20%0.35%)PTCA


9527CABG816331616427PTCA84%46CABG79%7519 +/- 713PTCA8CABG13


90LVEF35% (29% +/- 5%)96%30%38%118 77%(91/118)86% (82/95)39% (9/23)72% (65/90)5.5% (5)


53 +/- 4712219% (17/88)7184PTCA; 4CABG21(29%)50(71%)61(86%)81 +/- 4% and 79 +/- 5%LVEF


PTCA


2

182LVEF35% (30% +/- 4%)61 +/- 1078%15395%(271/284)24%7.1%73Q 4CABG


98.4%3271468 663110033125LVEF


PTCA

1995-11996-4 194LVEF< 30%1,390


LVEF(2.6 vs. 0.6%, p = 0.02)LVEFLVEF16%


3LVEF

19831989343LVEF40% (34%+/-5%) PTCA49695%7.6%2699%36 +/- 2256(18.2%)14(4.5%)7223%32PTCA29CABG


84% LVEF30%31%35%36%40%69%83%92%(p =.0001)

PTCA


4PTCA

74LVEF40% (29% +/- 9%)86%58%61%74%


46%5089.5%89.2%2.7%1.4%2.7%CABG

6629 +/- 336965887.9%4468.6%


402972.5%NYHA1PTCA23.5% vs 43.8%, p=0.08

PTCAPTCA


1


301980180%(1)(2)(3) (4)5


2

(TMLR)CO2TMLRFDACABGPTCA1


19CABGPTCATMLR117483%15/181-308CABGTMLR172921.2(6-53)


TMLRTMLR 2000FDATMLR

TMLR111,470 2,586TMLR


3VEGF

VEGF


DNA


VEGF(<6min)


DNAVEGFCABGPTCA


4

2001Hamano


1199911Hamano5CABG66


5221cm113


Tomita5


Orlicconnexin


5


1

UCGPET173


2



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