胎儿心脏定量技术对评估动脉导管收缩或闭合胎儿心脏形态和功能的价值

Analysis of cardiac morphology and function based on Z-scores in fetuses with ductus arteriosus constriction or closure by fetal heart quantification

目的探讨胎儿心脏定量技术(FHQ)评估动脉导管提前收缩或闭合胎儿心脏大小、形状及功能变化的价值。方法选取2013年5月至2020年1月于首都医科大学附属北京安贞医院超声科经产前心脏超声检查诊断为动脉导管收缩/闭合(动脉导管收缩/闭合组)的50例单胎妊娠胎儿(动脉导管提前收缩35例,其中16例为轻-中度狭窄,19例为中-重度狭窄;动脉导管完全闭合者15例)作回顾性分析,选择同期50名健康胎儿作为正常对照组,采集所有胎儿标准的四腔心切面动态图像,在舒张末期测量胎儿心脏心底至心尖长度(4CV Length)、横向宽度(4CVWidth)、面积(4CVArea),计算心脏整体球形指数(GSI),将左心室、右心室由基底至心尖分为24节段,利用FHQ技术追踪获得心室内膜动态曲线,测量计算各节段横向宽度(ED)、球形指数(SI)、短轴缩短分数(FS)及其经胎龄校正后的Z评分值,当Z值>+1.65(>第95百分位数)或Z值<-1.65(<第5百分位数)定义为“异常”。应用独立样本t检验从胎儿心脏大小、形状及功能方面比较动脉导管收缩/闭合组和正常对照组、收缩组和闭合组、轻-中度狭窄组和中-重度狭窄组以及中-重度狭窄组和闭合组间Z值的差异。结果与正常对照组相比,动脉导管收缩/闭合组右心室ED在24节段均明显增大(Z值>+1.65),右心室SI在基底、中间段减低(Z值<-1.65),左心室、右心室的24节段FS均不同程度减低(Z值<-1.65);与轻-中度狭窄组相比,中-重度狭窄组左心室ED减小、SI增大、FS增大(P均<0.05);与中-重度狭窄组相比,闭合组左心室ED、右心室ED及左心室FS增大,左心室SI、右心室SI及右心室FS减小(P均<0.05)。结论动脉导管收缩/闭合胎儿心脏多参数出现明显改变,FHQ技术能够为评估心脏大小、形态及功能提供更多有价值的信息,利用Z值评估个体相较正常人群的差异,可以更敏感、准确地评价组间差异。

Objective To evaluate the cardiac morphology and function of fetuses with premature ductus arteriosus constriction or closure(DA Con/Clo)by fetal heart quantification technology(FHQ).Methods This study retrospectively analyzed 50 singleton fetuses who underwent fetal echocardiography and were diagnosed with DA Con/Clo(35 cases with DA Con,including 16 cases of mild to moderate constriction and 19 cases of moderate to severe constriction;and 15 cases with DA Clo)from May 2013 to January 2020;50 healthy fetuses were randomly selected as a control group.The dynamic images of the standard four chamber view(4CV)were collected,and the end-diastolic area,length,and width were measured to determine the global sphericity index(GSI)of the 4CV.The left ventricle(LV)and right ventricle(RV)were divided into 24 segments(S1-24)from the base to the apex of the heart on 4CV,and speckle-tracking analysis was used to obtain the dynamic tracking curve of the ventricular intima and compute the end-diastolic width(ED),sphericity index(SI),and fractional shortening(FS)of the 24 segments of the RV and LV,as well as the Z-scores of these parameters after adjustment for gestational age.The Z-scores were valuated and defined as"more than or less than the normal range"when Z-score>+1.65(>95th centile)or Z-score<-1.65(<5th centile).Independent sample t-test was used to compare the Z scores of cardiac morphology,size,and function parameters between the DA Con/Clo and control groups,between the constriction and closure groups,between the mild to moderate constriction group and moderate to severe constriction group,and between the moderate to severe constriction group and closure group.Results Compared with the controls,RV-ED of S1-24 increased significantly(Z>+1.65),RV-SI was reduced in the basal-middle segment(Z<-1.65),and FS of S1-24 was depressed to varying degrees(Z<-1.65)in the DA Con/Clo group.Compared with the mild to moderate constriction group,LV-ED decreased significantly in the moderate to severe constriction group,and LV-SI and LV-FS increased(P<0.05).Compared with the moderate to severe constriction group,LV-ED,RV-ED,and LV-FS increased,and LV-SI,RV-SI,and RV-FS decreased in the closure group(P<0.05).Conclusion The cardiac parameters of DA Con/Clo fetuses have changed significantly.FHQ technology can provide more valuable information for evaluating the changes of heart size,morphology,and function of fetuses with DA Con/Clo.Z-scores can be more sensitive and accurate in evaluating the differences of size,shape,and function of the fetus heart between these groups.