CHD双心治疗.ppt

1冠心病多元化治疗--心可舒双心治疗 2冠心病治疗观念的改变从重视管腔狭窄到易损斑块从注意脂质沉积到炎症反应从重视易损斑块到易损病人从一枝独秀到三驾马车 3 管腔狭窄易损斑块冠心病治疗观念改变之一时间进展缺血性心脏病脑血管病外周血管疾病动脉粥样硬化的传统认识动脉粥样硬化的传统认识正常血管正常血管进展进展(Progression) (Progression) 目前对动脉粥样硬化的认识: Glagov ’s模型 Source: Glagov et al., N Engl J Med , 1987. 失代偿:管腔狭失代偿:管腔狭窄窄重度重度 CAD CAD 轻度轻度 CAD CAD 血管代偿性扩张,维持血血管代偿性扩张,维持血管管管腔的直径管腔的直径中度中度 CAD CAD 逆转? 逆转? ( ( REVERSAL) REVERSAL) 6急性心梗前的冠脉狭窄程度<50% 50-70% >70% % of Diameter Stenosis % of Diameter Stenosis %% of the Patients of the Patients Bar graph shows severity of coronary artery stenosis before AMI (n=195, 4 studies) 68% patients had stenosis less than 50% at baseline 86% patients had stenosis less than 70% at baseline Falk et al. Circulation . 1995;92:657. 7 冠脉狭窄与心脏事件?提示: 斑块大小或冠脉狭窄严重程度并非心血管事件关键原因 A A A B B B B B BA A A A A A IVUS IVUS 测量显示,严重狭窄不是活动测量显示,严重狭窄不是活动病变病变 Images supplied by Steven E. Nissen, MD, Cleveland Clinic. Images supplied by Steven E. Nissen, MD, Cleveland Clinic. B B B 破裂区域破裂区域脂质核心脂质核心粥样斑块管腔管腔 mm mm mm mm IVUS 测量总斑块体积确定粥样硬化负荷