Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
J Am Soc Echocardiogr. 2017 Nov;30(11):1130-1137.e1. doi: 10.1016/j.echo.2017.07.013. Epub 2017 Sep 9.
Intraventricular pressure difference (IVPD), the diastolic suction during early diastole, is known as a useful marker of myocardial diastolic function in adults with different heart diseases, but there are no studies of fetal IVPD. The aim of this study was to determine whether IVPD exists and changes prenatally and whether IVPD correlates with preexisting parameters to evaluate fetal cardiac diastolic function and ventricular dominance.
Cross-sectional study data (stroke volume, fetal cardiac output, E/A ratio, and myocardial performance index) from 117 healthy fetuses at 17 to 36 weeks of gestation were retrospectively evaluated. The total IVPD was calculated using Euler's equation with color M-mode data. Segmental IVPD was evaluated as apical, mid, and basal IVPDs.
The total IVPD in the right ventricle and left ventricle significantly increased in late gestation compared with that in different fetuses studied at midgestation (right and left ventricles, ρ = 0.813 and ρ = 0.895, respectively; P < .001). In both ventricles, the apical IVPD percentage, but not basal or mid IVPD, significantly increased at late gestation compared with that in different fetuses studied at midgestation. Both stroke volumes were correlated with IVPD (right and left ventricles, ρ = 0.796 and ρ = 0.784, respectively; P < .001). Although myocardial performance index in the left ventricle did not show a significant correlation with IVPD, the E/A ratio had a very weak correlation with IVPD (right ventricle, ρ = 0.576, P < .001; left ventricle, ρ = 0.338, P < .01).
IVPD has been proved to exist in both ventricles during the fetal stage. The total IVPD increased in late gestation, and the ventricular length increased because of increased apical IVPD in both ventricles. Furthermore, the increase of IVPD in both ventricles was correlated with stroke volume and, accordingly, cardiac output. Left ventricular dominance in IVPD from the fetal stage may offer interesting insight into fetal cardiac development.
心室间压力差（IVPD）是舒张早期的舒张抽吸，被认为是一种评估患有不同心脏病的成年人心肌舒张功能的有用标志物，但尚未有关于胎儿 IVPD 的研究。本研究旨在确定 IVPD 是否存在并在产前发生变化，以及 IVPD 是否与现有参数相关，以评估胎儿心脏舒张功能和心室优势。
回顾性评估了 117 名 17 至 36 周妊娠的健康胎儿的超声心动图数据（每搏输出量、胎儿心输出量、E/A 比值和心肌性能指数）。使用 Euler 方程和彩色 M 型数据计算总 IVPD。节段性 IVPD 评估为心尖、中部和基底 IVPD。
与中期妊娠不同胎儿相比，右心室和左心室的总 IVPD 在晚期妊娠时明显增加（右心室和左心室，ρ=0.813 和 ρ=0.895，均 P<.001）。在两个心室中，与中期妊娠不同胎儿相比，心尖 IVPD 百分比（而非基底或中部 IVPD）在晚期妊娠时明显增加。两个心室的每搏输出量均与 IVPD 相关（右心室和左心室，ρ=0.796 和 ρ=0.784，均 P<.001）。虽然左心室心肌性能指数与 IVPD 无显著相关性，但 E/A 比值与 IVPD 呈弱相关（右心室，ρ=0.576，P<.001；左心室，ρ=0.338，P<.01）。
IVPD 在胎儿期已被证明存在于两个心室中。总 IVPD 在晚期妊娠时增加，由于两个心室的心尖 IVPD 增加，心室长度增加。此外，两个心室的 IVPD 增加与每搏输出量相关，进而与心输出量相关。从胎儿期开始，IVPD 左心室优势可能为胎儿心脏发育提供有趣的见解。
