胎儿心脏定量分析技术评估小于胎龄儿和生长受限儿心室功能

Application of fetal heart quantitation in evaluation of ventricular function of fetuses with small-for-gestational-age and growth restriction

目的探讨胎儿心脏定量分析(fetal HQ)技术在评估小于胎龄儿(SGA)及生长受限(FGR)胎儿心室收缩功能中的应用价值。方法前瞻性选取2022年8月至2023年9月郑州大学第三附属医院胎儿预估体重(EFW)或腹围小于第10百分位数的单胎胎儿152例,其中胎儿EFW或腹围位于第3~10百分位数且不伴有血流动力学异常为SGA组(n=79),其余为FGR组(n=73);匹配同期正常单胎胎儿161例作为对照组。依据FGR发生孕周,将FGR组分为早发组(<32周,46例)与晚发组(≥32周,27例),同时将FGR组中脐动脉舒张末期血流信号消失定义为重度FGR(n=11),其余为轻度FGR(n=62)。应用fetal HQ软件获取胎儿心室面积变化分数(FAC)、整体纵向应变(GLS)、纵向缩短率(LFS)及24节段短轴缩短率(FS),比较各组间心室收缩功能差异,分析各参数与孕周的相关性,进行观察者间及观察者内重复性检验。结果与对照组相比,SGA组及FGR组心室FAC、LFS及GLS均减低,SGA组右心室9~24节段FS减低、FGR组左心室10~19、21~24节段及右心室18~24节段FS减低,差异有统计学意义(均P<0.05)。重度FGR组左心室GLS、LFS及右心室FAC、GLS、LFS、1~14节段FS低于轻度FGR组,差异有统计学意义(均P<0.05)。FGR早发组左心室GLS及LFS高于晚发组,差异有统计学意义(均P<0.05)。ROC结果显示FAC、GLS、LFS预测不良围产期结局AUC>0.6(均P<0.05)。FGR组左心室GLS及右心室部分节段FS与孕周呈弱相关(-0.3<rs<0.3,均P<0.05),SGA组各参数与孕周无相关性(均P>0.05)。心室收缩功能参数观察者间及观察者内ICC均>0.75,具有较好的重复性。结论Fetal HQ可定量评估SGA及FGR胎儿心室收缩功能,SGA及FGR胎儿心室整体、纵向及局部横向收缩功能均减低,心室收缩功能异常与不良围产期结局相关。

Objective To investigate the value of fetal heart quantification(fetal HQ)in assessing ventricular function of fetuses with small-for-gestational-age(SGA)and fetal growth restriction(FGR).Methods A total of 152 singleton pregnancies with estimated fetal weight(EFW)or abdominal circumference less than the 10th percentile in the Third Affiliated Hospital of Zhengzhou University were prospectively selected from August 2022 to September 2023,where fetal EFW or abdominal circumference were in the 3rd to 9th percentile with normal Doppler findings were classified as the SGA group(n=79),and the rest as the FGR group(n=73).In the same period,161 cases of normal single fetuses were matched as the control group.Based on the gestational week in which FGR occurred,the FGR group were categorized into the early-onset group(<32 weeks,n=46)and the late-onset group(≥32 weeks,n=27),and fetuses in the FGR group with absent end-diastolic velocity of the umbilical artery were defined as severe FGR(n=11),and the rest as mild FGR(n=62).Fetal ventricular fractional area change(FAC),global longitudinal strain(GLS),longitudinal fractional shortening(LFS)and 24-segment fractional shortening(FS)were obtained by fetal HQ.The cardiac systolic function between groups were compared,the correlations between each parameter and gestational week were analyzed,the inter-observer and intra-observer repeatability tests were performed.Results Compared with the control group,ventricular FAC,LFS,and GLS were lower in the SGA and the FGR group,right ventricular FS of segments 9-24 were reduced in the SGA group,and left ventricular FS of segments 10-19,21-24 and right ventricular FS of segments 18-24 were reduced in the FGR group,the differences were statistically significant(all P<0.05).Left ventricular GLS,LFS and right ventricular FAC,GLS,LFS,FS of segments 1-14 were lower in the severe FGR group than in the mild FGR group,the differences were statistically significant(all P<0.05).The values of left ventricular GLS and LFS were higher in the early-onset FGR group than in the late-onset FGR group,the differences were statistically significant(all P<0.05).The ROC showed that the ventricular systolic function parameters predicted adverse perinatal outcomes with an AUC>0.6(all P<0.05).Left ventricular GLS and right ventricular partial-segments FS were no correlations with gestational week in the FGR group(-0.3<r s<0.3,all P<0.05).There was no correlation between the parameters and gestational week in the SGA group(all P>0.05).The inter-observer and intra-observer intraclass correlation coefficients(ICC)were>0.75,with good reproducibility.Conclusions Fetal HQ can quantitatively assess the changes of ventricular function in SGA and FGR fetuses,and the ventricular overall,longitudinal and localized contractile function in SGA and FGR fetuses are reduced,and abnormal ventricular systolic function is associated with adverse perinatal outcomes.