Sinkovskaya Elena S, Chaoui Rabih, Karl Katrin, Andreeva Elena, Zhuchenko Ludmila, Abuhamad Alfred Z
Departments of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, and Maistrasse, Ludwig-Maximilians-University, Munich, Germany; the Prenatal Diagnosis Center, Berlin, Germany; and the Moscow Regional Research Scientific Institute of Obstetrics and Gynecology, Moscow, Russia.
Obstet Gynecol. 2015 Feb;125(2):453-460. doi: 10.1097/AOG.0000000000000608.
To investigate the association between cardiac axis and fetal congenital heart defects to demonstrate the potential clinical applicability of cardiac axis measurement for detection of congenital heart defect in early gestation.
This case-control study was undertaken in three tertiary centers with expertise in fetal imaging in early gestation. Fetal cardiac axis was evaluated between 11 0/7 and 14 6/7 weeks of gestation in 197 fetuses with confirmed congenital heart defects. A control group was selected by matching each fetus with a congenital heart defect with two fetuses in the control group with similar crown-rump length (± 5 mm) and date of study (± 2 months). Cardiac axis was measured on the four-chamber view as the angle between the line that traces the long axis of the heart and the line that bisects the thorax in an anteroposterior direction.
In the control group, mean cardiac axis was 44.5 ± 7.4°. The cardiac axis did not significantly change in early pregnancy. In the congenital heart defect group, 25.9% of fetuses had cardiac axis measurements within normal limits. In 74.1%, the cardiac axis was abnormal including 110 fetuses in the case group with left deviation (cardiac axis > 97.5th percentile), 19 fetuses in the case group with right deviation (cardiac axis < 2.5th percentile), and 17 fetuses in the case group with nonidentifiable cardiac axis. The performance of cardiac axis measurement in detection of major congenital heart defect was significantly better than enlarged nuchal translucency, tricuspid regurgitation, or reversed A-wave in ductus venosus used alone or in combination.
Abnormal cardiac axis is present in two-thirds of fetuses with congenital heart defect in early gestation. Adding cardiac axis assessment to the nuchal translucency measurement is helpful in defining a population at risk for fetal congenital heart defect.
研究心脏轴与胎儿先天性心脏缺陷之间的关联，以证明测量心脏轴在孕早期检测先天性心脏缺陷方面的潜在临床适用性。
本病例对照研究在三个具有孕早期胎儿成像专业知识的三级中心进行。在197例确诊先天性心脏缺陷的胎儿中，于妊娠11⁰/₇至14⁶/₇周评估胎儿心脏轴。通过将每例先天性心脏缺陷胎儿与对照组中两名头臀长度相似（±5mm）且研究日期相近（±2个月）的胎儿进行匹配来选择对照组。在四腔心视图上测量心脏轴，即追踪心脏长轴的线与在前后方向上平分胸部的线之间的夹角。
对照组中，平均心脏轴为44.5±7.4°。孕早期心脏轴无显著变化。在先天性心脏缺陷组中，25.9%的胎儿心脏轴测量值在正常范围内。74.1%的胎儿心脏轴异常，其中病例组有110例胎儿心脏轴左偏（心脏轴>第97.5百分位数），19例胎儿心脏轴右偏（心脏轴<第2.5百分位数），17例胎儿心脏轴无法识别。单独或联合使用心脏轴测量在检测主要先天性心脏缺陷方面的表现明显优于单纯使用增厚的颈项透明层、三尖瓣反流或静脉导管A波倒置。
三分之二的孕早期先天性心脏缺陷胎儿存在心脏轴异常。将心脏轴评估添加到颈项透明层测量中有助于确定胎儿先天性心脏缺陷的高危人群。
