胎儿心脏定量分析技术评价双绒毛膜双羊膜囊胎儿心室收缩功能的应用研究

Application research of fetal HQ in the systolic function of 24 segments in dichorionic diamniotic twin pregnancy

目的使用胎儿心脏定量分析(fetal HQ)技术评估双绒毛膜双羊膜囊(DCDA)胎儿24节段的心室收缩功能,比较其与单胎胎儿的差异。方法选取2022年2月至2023年2月在郑州大学第三附属医院进行围生期保健的DCDA双胎妊娠31例(观察组)及与其孕周匹配的单胎妊娠100例(对照组)。应用fetal HQ技术比较DCDA胎儿与单胎胎儿之间左右心室整体应变(GS)、面积变化分数(FAC)及24节段短轴缩短率(FS)的差异。选择DCDA双胎宫内生长不一致1例验证该技术的实用性。结果①观察组内两胎儿之间左右心室GS、FAC及24节段FS差异无统计学意义(均P>0.05)。②DCDA胎儿左心室FS 1~10节段大于单胎胎儿,差异有统计学意义(均P<0.05);观察组与对照组之间胎儿左右心室GS、FAC、左心室FS 11~24节段及右心室FS 1~24节段差异无统计学意义(均P>0.05)。组内相关系数(ICC)均>0.75,重复性良好。③DCDA双胎宫内生长不一致的两个胎儿左心室及右心室部分节段FS均有异常。结论Fetal HQ技术可以简单可靠评估DCDA胎儿心功能,且重复性良好。双胎妊娠胎儿的心功能改变,并不总是遵循单胎的变化规律,在进行临床管理和科学研究时,双胎不能盲目应用单胎的相关数据。

Objective To evaluate the systolic function of 24 segments in dichorionic diamniotic(DCDA)twin pregnancy by fetal heart qualification(fetal HQ)analysis,and to compare the difference with singleton pregnancies.Methods Thirty-one cases of DCDA twin pregnancy(observation group)and 100 cases of singleton pregnancy(control group)matched in gestational age were enrolled.They underwent perinatal health care in the Third Affiliated Hospital of Zhengzhou University from February 2022 to February 2023.Fetal HQ was applied to track endocardial motion trajectories and automatically calculate the global strain(GS),fractional area change(FAC)and fractional shortening(FS)of 24 segments of left and right ventricles in order to compare the difference between DCDA fetuses and singleton fetuses.One case of twins with growth discordance were selected to demonstrate the utility of this technique.Results①There were no statistically significant differences in GS,FAC and 24-segments FS of left and right ventricles between the two fetuses in the observation group(all P>0.05).②The LV-FS of segments 1-10 were higher in the observation group than the control group,and the differences were statistically significant(all P<0.05).However,there were no statistically significant differences in GS and FAC of left and right ventricles,LV-FS of segments 11-24 and RV-FS of segments 1-24 between the observation group and the control group(all P>0.05).The intraclass correlation coefficient(ICC)was greater than 0.75,indicating good repeatability.③Two fetuses with discordant growth in dichorionic diamniotic twins had abnormal FS in some segments of the left and right ventricles.Conclusions Fetal HQ technology could easily and reliably evaluate fetal heart function in DCDA pregnancy with good repeatability.The changes of fetal cardiac function in twin pregnancy did not always follow the same pattern as in singleton pregnancy.The related data of singleton pregnancy should not be blindly used in the clinical management and scientific research of twin pregnancy.