组织多普勒成像对心脏内强回声结构胎儿心功能的研究

Evaluation of fetal cardiac function with intracardiac hyperechogenic focus by tissue Doppler imaging

目的应用组织多普勒成像（TDI）结合传统超声综合评价心脏内强回声结构（ICEF）胎儿的心功能。方法应用TDI技术的脉冲方式观察ICEF胎儿房室瓣环运动，测量其舒张早期、舒张晚期及收缩期运动的峰值速度（Em、Am、Sm）；并结合传统二维、M型及脉冲多普勒超声测量胎儿心脏大小及血流速度系列参数；对照组房室瓣口血流参数与房室瓣环运动参数进行相关分析；两组间评价心脏收缩及舒张功能参数进行独立样本t检验；两组间Em／Am随孕周的变化进行直线回归分析。结果研究组房室瓣E／A及Em／Am显著低于对照组，并与孕周呈直线关系；对照组E与Em、A与Am、E／A与Em／Am、左室缩短分数与Sm之间呈正相关；两组评价心脏大小各参数之间、心脏收缩功能参数及不同孕期Sm比较差异无统计学意义。结论TDI可更为敏感、准确地评价胎儿心脏功能；中晚孕期ICEF胎儿心脏舒张功能下降。

Objective To evaluate cardiac function in fetuses with intracardiae hyperechogenic focus （ICEF） by tissue Doppler imaging（TDI）. Methods Fetal echocardiography was performed in 335 fetuses for evaluation of fetal cardiac function with ICEF by TDI, two-dimensional, M-mode and pulsed Doppler echocardiography. The ratio between early ventricular filling （E-wave） and active atrial filling （A-wave） peak velocities at the level of the atrioventricularvalves as an index of ventricular diastolic function. TDI mode was used to measure the mitral and tricuspid valve annulus including Em, Am and Sm. The characteristics of fetal echocardiography of 119 fetuses with ICEF were compared with 137 normal fetuses. Results E/A and Em/Am were significantly lower in fetuses with ICEF than in control fetuses. Positive correlation was found between the velocity of orifice and annulus in controls. No systematic differences were found in cardiac dimensions, ventricular shortening fraction, Doppler and TDI systolic indices between groups. Conclusions TDI is feasible and reproducible to evaluate fetal ventricular function,and it can avoid the influence of fetal heart rates and preloading. Fetuses with ICEF show lower Em/Am values in the second to third trimester echocardiography,it might indicate cardiac diastolic dysfunction.