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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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4109396


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LVEF0.350.435%60%


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CABG

1

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


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  • 1) Q

  • 2) Tl-201

  • 3) LVEF

  • 4)

    1 NYHA IV

    2) (LBBB)


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CABG5NYHA IV LBBB


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2

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


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


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LVEF< 30%


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NYHA


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3

49CABGA19CABGB30212


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A321RVEF(LVEDD)(RVEF)


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CABGRVEFCABG


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5

26CABG201Tl18F2665722%62(23%)14756%314


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61%3149%1431%31461%


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PTCA

1PTCA

19871991100LVEF35% (0.20%0.35%)PTCA


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


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


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


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PTCA


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2

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


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98.4%3271468 663110033125LVEF


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PTCA

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


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


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3LVEF

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


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

PTCA


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4PTCA

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


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

6629 +/- 336965887.9%4468.6%


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

PTCAPTCA


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1


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


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2

(TMLR)CO2TMLRFDACABGPTCA1


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


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TMLRTMLR 2000FDATMLR

TMLR111,470 2,586TMLR


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3VEGF

VEGF


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DNA


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VEGF(<6min)


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DNAVEGFCABGPTCA


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4

2001Hamano


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1199911Hamano5CABG66


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5221cm113


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Tomita5


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Orlicconnexin


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5


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1

UCGPET173


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2


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