心肌“缺血记忆”分子影像诊断研究进展

Progress of molecular imaging in myocardial ＂ischemia memory＂

急性心肌缺血的识别通常是基于心电图的改变、超声心动图发现的室壁运动异常和血清生物标志物的升高等。以“胸痛”为首发症状就诊的患者日益增多．一些急性胸痛者往往其心电图、血清标志物甚至CAG阴性而导致漏诊误诊。急性心肌缺血可引起一系列病理生理学现象，如心肌灌注减低、脂肪酸和葡萄糖代谢异常及神经功能异常等。急性心肌缺血在缺血再灌注后，代谢异常和神经功能损伤还会持续，即“代谢顿抑”或“缺血记忆”。笔者在概述心肌缺血的病理生理基础上，总结近年来分子影像学手段诊断心肌“缺血记忆”的研究进展。

Acute myocardial ischemia is usually identified based on electrocardiography changes, wall motion abnormalities found on echocardiography, elevated serum biomarkers, etc. In recent years, the number of patients with chest pain as the first symptom has been increasing. However, in some patients with a- cute chest pain, electrocardiography changes may be non-diagnostic and without serum biomarkers elevation, which leads to misdiagnosis. Acute myocardial ischemia may cause a series of pathophysiological phenomena, such as myocardial perfusion reduction, abnormal metabolism of fatty acid and glucose as well as malfunction of cardiac nerve system. Myocardial perfusion may be normal shortly after restoration of coronary blood flow. However, the changes of metabolic and nervous function may persist longer. The remained changes in metabo- lism and nervous function after ischemia event were named as metabolic stunning or ischemic memory. This review focuses on the research progress of molecular imaging in the evaluation of myocardial ＂ischemia memory＂.