Reproductive Biology, Division of Cancer, Faculty of Medicine, Imperial College London, London, UK.
Fetal Diagn Ther. 2012;32(1-2):123-30. doi: 10.1159/000334413. Epub 2012 May 25.
To compare myocardial deformation patterns in fetuses with congenital heart disease (CHD) with our reference range using speckle tracking echocardiography.
We prospectively stored and analyzed 4-chamber loops of 28 fetuses with CHD (median gestation 27 weeks, range 20.9-37.0). The peak longitudinal left (LVs) and right (RVs) ventricular free wall Lagrangian strain and LV/RV strain ratio were measured from Syngo VVI software- (Siemens) derived original coordinates. Strain values from the first examination were compared with normative data from the same population using ANOVA with post hoc tests and serial examinations described in 14 fetuses.
Simple shunt lesions (0.82) and shunts with pulmonary stenosis or atresia (0.93) had reduced mean LV/RV strain ratios compared to normal fetuses (1.01; 95% CI 0.97-1.05). Fetuses with hypoplastic left heart had the lowest (0.29), and those with Ebstein the highest (1.55), LV:RV ratio. Serial measurements showed increased LVs in aortic coarctation and aortic stenosis, but not in one developing important mitral regurgitation. Increased right ventricular loading in a fetus developing pulmonary regurgitation was associated with increasing RVs.
Myocardial strain reflects the changing physiology of fetal CHD. Speckle tracking might be a useful tool to study the progress of myocardial function in affected fetuses.
利用斑点追踪超声心动图比较先天性心脏病（CHD）胎儿与参考范围的心肌变形模式。
我们前瞻性地存储和分析了 28 例 CHD 胎儿（中位孕龄 27 周，范围 20.9-37.0）的 4 腔心环。从 Syngo VVI 软件（西门子）获得的原始坐标测量左（LVs）和右（RVs）心室游离壁的纵向峰值朗格朗日应变和 LV/RV 应变比。使用方差分析（ANOVA）和后验检验比较第一次检查的应变值与同一人群的参考值，并对 14 例胎儿进行连续检查。
单纯分流病变（0.82）和伴有肺动脉瓣狭窄或闭锁的分流病变（0.93）的 LV/RV 应变比均低于正常胎儿（1.01；95%置信区间 0.97-1.05）。左心发育不良的胎儿最低（0.29），Ebstein 畸形的胎儿最高（1.55）。左心室：右心室比值。连续测量显示主动脉缩窄和主动脉瓣狭窄的左心室增大，但在一个发展为严重二尖瓣反流的胎儿中没有增大。在一个发展为肺动脉瓣反流的胎儿中，右心室负荷增加与 RVs 的增加有关。
心肌应变反映了胎儿 CHD 的不断变化的生理学。斑点追踪可能是研究受影响胎儿心肌功能进展的有用工具。
