斑点追踪技术评估三尖瓣反流胎儿右心室功能

Speckle tracking imaging for assessing right ventricular function in tricuspid regurgitation fetus

目的探讨斑点追踪技术评估胎儿不同程度三尖瓣反流时右心室功能的变化。方法选择2019年1月~2023年5月在中国科学技术大学附属第一医院(安徽省立医院)经产前超声心动图检查未见明显心脏畸形的101例胎儿,根据三尖瓣反流程度将其分为无反流对照组(n=41)、轻度反流组(n=30)、中度反流组(n=30)。计算左、右心室心内膜下心肌整体纵向应变,左、右心室面积变化率,右室游离壁应变,三尖瓣环位移及左心室射血分数。比较不同程度三尖瓣反流对胎儿左、右心室收缩功能的影响。结果轻度反流组与对照组的右心室功能各项指标差异无统计学意义(P>0.05);中度反流组右心室功能各指标均比对照组减小(P<0.05);中度反流组与轻度反流组比较,右心室心内膜下心肌整体纵向应变、右室游离壁应变数值减小(P<0.05),右心室面积变化率和三尖瓣环位移差异无统计学意义(P>0.05);各组胎儿左心室功能各指标差异无统计学意义(P>0.05)。结论斑点追踪技术可评价单纯三尖瓣反流胎儿右室功能是否受损,右心室心内膜下心肌整体纵向应变、右室游离壁应变是较为敏感的指标。

Objective To investigate the changes in fetal right ventricular function associated with tricuspid regurgitation by speckle tracking imaging.Methods A total of 101 fetuses without obvious cardiac malformations detected by prenatal echocardiography from January 2019 to May 2023 at the First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital)were selected.The fetuses were divided into a control group with no tricuspid regurgitation(n=41),a mild regurgitation group(n=30),and a moderate regurgitation group(n=30)based on the degree of tricuspid regurgitation.The left and right ventricular global longitudinal strain of endocardial layers(LV/RV-EndoGLS),fractional area change in the left and right ventricles(LV/RV-FAC),right ventricular free wall strain(RVFWLS),tricuspid annular plane systolic excursion(TAPSE),and left ventricular ejection fraction(LVEF)were computed to compare the impact of different degrees of tricuspid regurgitation on biventricular systolic function in fetuses.Results There was no significant difference in right ventricular function between the mild regurgitation group and the control group(P>0.05).The right ventricular function indicators in the moderate regurgitation group were all lower than those in the control group(P<0.05).The RV-EndoGLS and RVFWLS in the moderate regurgitation group were lower than those in the mild regurgitation group(P<0.05),while RVFAC and TAPSE showed no significant difference(P>0.05).There was no significant difference in LV-EndoGLS,LV-FAC,and LVEF among all the groups(P>0.05).Conclusion The speckle tracking imaging can evaluate whether the fetal right ventricular function is impaired in isolated tricuspid regurgitation.RV-EndoGLS and RVFLS are more sensitive indicators.