胎儿心脏定量分析技术对肺动脉狭窄及肺动脉闭锁胎儿心脏形态及功能的初步研究

Preliminary study on fetal heart morphology and function in pulmonary stenosis and pulmonary atresia using fetal heart quantification

目的应用胎儿心脏定量分析技术(fetal HQ)定量分析肺动脉狭窄(PS)和肺动脉闭锁(PA)胎儿心脏形态及左、右心室收缩功能,评估不同程度右心室流出道梗阻(RVOTO)对胎儿左、右心室收缩功能的影响,为构建一种胎儿PS及PA进展预测模型和临床决策工具进行早期的数据积累和参数探索。方法回顾性选取2020年7月至2021年12月在浙江大学医学院附属邵逸夫医院超声科行胎儿超声心动图检出的轻中度PS胎儿42例和重度PS或PA胎儿23例作为病例组,选取与其孕周相匹配的正常胎儿195例作为对照组,利用fetal HQ技术测量两组胎儿整体球形指数(GSI),左心室射血分数(LVEF),左、右心室面积变化率(LVFAC、RVFAC)和左、右心室纵向应变(LVGLS、RVGLS)以及左心室和右心室各自的24节段球形指数(SI)、短轴缩短率(FS),分析比较病例组与对照组及病例组内的差异。结果与对照组比较,病例组GSI、LVGLS、LVEF、LVFAC、RVGLS、RVFAC均减低,轻中度PS组差异有统计学意义(均P<0.05),重度PS/PA组差异有统计学意义(均P<0.01);轻中度PS组左心室第2节段、右心室第24节段SI和左心室第1~13节段、右心室第1~16节段、右心室第20~24节段FS与对照组比较差异有统计学意义(均P<0.05);重度PS/PA组右心室第1~22节段SI和左心室第6~13节段、左心室第21~24节段、右心室第1~14节段FS减低,与对照组比较差异有统计学意义(均P<0.05);重度PS/PA组RVGLS、RVFAC、右心室第1~17节段SI较轻中度PS组减低(均P<0.05)。结论初步研究结果显示fetal HQ提供的定量指标可以用于罹患PS/PA胎儿的心脏形态及功能的评估,为进一步深入了解此类胎儿的心脏形态与功能改变提供参考信息。

Objective To evaluate the morphological characteristics of the fetal heart and the contractile function of the left and right ventricles in fetuses with pulmonary stenosis(PS)and pulmonary atresia(PA)using fetal heart quantitative analysis technology(fetal HQ),and to assess the impact of different degrees of right ventricular outflow tract obstruction(RVOTO)on the contractile function of the fetal left and right ventricles.To accumulate early data and explore parameters for constructing a predictive model and clinical decision-making tool for the progression of fetal PS and PA.Methods A retrospective analysis was conducted on 42 cases of mild to moderate PS and 23 cases of severe PS or PA detected through fetal echocardiography in the Department of Ultrasound,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,from July 2020 to December 2021.A control group of 195 normal fetal cases matching gestational weeks was selected.The fetal HQ technique was employed to measure the global sphericity index(GSI),left ventricular ejection fraction(EF),left/right ventricular area change percentage(LVFAC,RVFAC),and left/right ventricular longitudinal strain(LVGLS,RVGLS).Additionally,24-segment sphericity index(SI)and fractional shortening(FS)for both left and right ventricles were measured.Comparative analyses were performed between the case and control groups,as well as within the case group.Results In comparison with the control group,the case group exhibited significantly decreased GSI,LVGLS,LVEF,LVFAC,RVGLS,and RVFAC.The differences were statistically significant in the mild to moderate PS group(all P<0.05)and highly significant in the severe PS/PA group(all P<0.01).In the mild to moderate PS group,the left ventricle′s 2nd segment,right ventricle′s 24th segment SI,and the left ventricle′s 1st-13th segments,right ventricle′s 1st-16th and 20th-24th segments FS showed statistically significant differences compared to the control group(all P<0.05).In the severe PS/PA group,the right ventricle′s 1st-22nd segment SI,and the left ventricle′s 6th-13th,21st-24th segments,and the right ventricle′s 1st-14th segments FS were reduced,showing statistically significant differences compared to the control group(all P<0.05).The severe PS/PA group showed lower RVGLS,RVFAC,and SI for the right ventricle′s 1st to 17th segments when compared to the mild to moderate PS group,with statistically significant differences(all P<0.05).Conclusions Quantitative indices derived by fetal HQ is capable of evaluating the cardiac morphology and function of fetuses with PS/PA,which may provide for reference information for comprehensive understanding of cardiac morphological and functional changes in such fetuses.