二维斑点追踪技术定量评估正常中晚孕期胎儿左右心房功能及其差异性

uantitative evaluation of left and right atrial function and its difference in normal fetus during middle and late pregnancy using two-dimensional speckle tracking echocardiography

目的探讨二维斑点追踪技术(2D-STE)在定量和评估正常胎儿左、右心房功能方面的应用价值,并探讨影响正常胎儿左、右心房功能的相关因素以及左、右心房功能存在的差异性。方法回顾性选取2019年1月至2022年10月在浙江大学医学院附属邵逸夫医院接受胎儿超声心动图检查且结果正常的单胎胎儿100例。获取标准的胎儿基底或心尖四腔心切面动态图像,通过TomTec-ARENA离线心脏分析软件对左心房、右心房进行定量分析,并获取胎儿应变测量值:左心房储存期纵向应变(LASr)、左心房导管期纵向应变(LAScd)、左心房收缩期纵向应变(LASct)、右心房储存期纵向应变(RASr)、右心房导管期纵向应变(RAScd)、右心房收缩期纵向应变(RASct),计算左心房及右心房收缩期纵向应变与导管期纵向应变比值,记作Sct/Scd。同时测量胎儿常规产科超声及胎儿心脏超声参数:胎儿心率(FHR)、左心房收缩末期长径(LAESL)、左心房收缩末期横径(LAESD)、左心房收缩末期面积(LAESA)、左心室舒张末期横径(LVEDD)、右心房收缩末期长径(RAESL)、右心房收缩末期横径(RAESD)、右心房收缩末期面积(RAESA)、右心室舒张末期横径(RVEDD)以及二尖瓣、三尖瓣舒张早期及晚期血流峰值速度E、A峰值比[E/A(MV)、E/A(TV)]。对比分析左、右心房各应变值及常规测量参数之间的差异性,分析左、右心房各应变值及各常规测量参数与孕周之间的相关性。采用组内相关系数(ICC)进行重复性检验。结果LASr与RASr、LAScd与RAScd、LASct与LAScd、左心房与右心房Sct/Scd、E/A(MV)与E/A(TV)、LAESD与RAESD、LAESL与RAESL差异有统计学意义(均P<0.05),左心房收缩显示组与未显示组的FHR差异有统计学意义(P=0.011),余参数比较差异无统计学意义(均P>0.05)。相关性分析显示,LASr、LASct、RASr、RASct与孕周呈中等负相关(r_(s)=-0.570、-0.601、-0.469、-0.568,均P<0.001);LAScd、RAScd、E/A(MV)、E/A(TV)与孕周呈中等正相关(r_(s)=0.310、0.350、0.330、0.343,均P<0.05);LAESL、LAESD、LAESA、RAESL、RAESD、RAESA、LVEDD及RVEDD与孕周呈显著正相关(r_(s)=0.662、0.768、0.792、0.728、0.828、0.822、0.838、0.802,均P<0.001)。胎儿LASr、RASr的观察者间ICC分别为0.89、0.84(均P<0.05),观察者内的ICC均为0.80(均P<0.05),一致性好。结论2D-STE在胎儿心房功能评估中具有良好的可行性和可重复性,本研究获得了不同孕周胎儿心房的不同时相应变值,为进一步研究正常胎儿心房以及为产前病理状况下胎儿心脏功能的对比分析提供了新的参考指标。

Objective To explore the potential application of two-dimensional speckle tracking echocardiography(2D-STE)in terms of quantification and evaluating left and right atrial function in normal fetuses,and to investigate the relevant factors affecting left and right atrial function in normal fetuses as well as differences between both atrial function.Methods A total of 100 single fetuses underwent fetal echocardiography in the Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College of Medicine from January 2019 to October 2022 were retrospectively enrolled.The standard basal or apical four-chamber view clips were obtained,and the left and right atrial function were quantitatively analyzed using TomTec-ARENA off-line cardiac analysis software for quantitative assessment of both atrial strain measurements including left atrial reservoir phase longitudinal strain(LASr),left atrial ductal phase longitudinal strain(LAScd),left atrial systolic phase longitudinal strain(LASct),right atrial reservoir phase longitudinal strain(RASr),right atrial ductal phase longitudinal strain(RAScd),right atrial systolic phase longitudinal strain(RASct),and the ratio of systolic longitudinal strain to conduit longitudinal strain in left and right atrial systolic display groups were calculated which was denoted as Sct/Scd.Routine fetal obstetric ultrasound measurements and fetal echocardiographic parameters in the two groups were obtained including fetal heart rate(FHR),left atrial end-systolic length(LAESL),left atrial end-systolic diameter(LAESD),left atrial end-systolic area(LAESA),left ventricular end-diastolic transverse diameter(LVEDD),right atrial end-systolic length(RAESL),right atrial end-systolic diameter(RAESD),right atrial end-systolic area(RAESA),right ventricular end-diastolic transverse diameter(RVEDD),peak blood flow velocity of mitral valve and tricuspid valve in early and late diastolic period(E,A),peak ratio of E and A:E/A(MV),E/A(TV),and the difference between the left and right atrial strain indices and the routine fetal obstetric ultrasound and fetal echocardiographic parameters,as well as the correlation between the above parameters and gestational age were analyzed.The repeatability tests were performed using the intra-class correlation coefficientt(ICC).Results Significant differences were found in LASr and RASr,LAScd and RAScd,LASct and LAScd,Sct/Scd between the left atrium and right atrium,E/A(MV)and E/A(TV),LAESD and RAESD,LAESL and RAESL(all P<0.05),there was significant difference in FHR between the left atrial contraction display group and the no atrial contraction display group(P=0.011),no significant difference in other parameters(all P>0.05).Correlation analysis showed that,LASr,LASct,RASr,and RASct showed moderate negative correlation with gestational age(r_(s)=-0.570,-0.601,-0.469,-0.568;all P<0.001).While LAScd,RAScd,E/A(MV),E/A(TV)were moderately positively related with gestational age(r_(s)=0.310,0.350,0.330,0.343;all P<0.05).LAESL,LAESD,LAESA,RAESL,RAESD,RAESA,LVEDD and RVEDD were significantly positively related with gestational age(r_(s)=0.662,0.768,0.792,0.728,0.828,0.822,0.838,0.802,all P<0.001).The inter-examiner ICC of fetal LASr and RASr were 0.89 and 0.84(both P<0.05)and the intra-examiner ICC of fetal RASr and LASr both were 0.80(both P<0.05),with good consistency.Conclusions 2D-STE is highly feasible and reproducible in assessing fetal atrial function.The corresponding variation values of fetal atria at different gestational weeks were obtained in this study,which provides a new reference index for us to further study normal fetal atria as well as comparative analysis of fetal cardiac function under prenatal pathological conditions.