Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO, USA.
The Colorado Fetal Care Center, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO, USA.
Ultrasound Obstet Gynecol. 2019 Nov;54(5):625-633. doi: 10.1002/uog.20245.
The objectives of this study were, first, to evaluate the association between fetal echocardiographic atrioventricular (AV) and magnetocardiographic (fMCG) PR intervals at different gestational ages (GAs) in normal and anti-Ro/SSA-antibody-positive pregnancies; second, to determine if PR interval could be predicted by AV interval; and third, to assess the neonatal outcome of fetuses with prolonged AV and PR intervals, with the goal of developing criteria for fetal first-degree AV block (AVB-I).
This was a retrospective study of anti-Ro/SSA-antibody-positive pregnancies (cases) and controls that underwent fMCG and fetal echocardiography at the same recording session. Cardiac cycle length, GA and AV (by mitral inflow/aortic outflow Doppler) and PR (by fMCG) intervals were measured. We tested for significant differences between AV and PR intervals using generalized estimating equations to account for repeat measurements, and assessed whether PR interval could be predicted reliably by AV interval. After delivery, infants with fetal AV or PR interval Z-score ≥ 3 underwent 12-lead electrocardiography.
Thirty-nine controls and 31 cases underwent 46 and 36 simultaneous fMCG and echocardiographic examinations, respectively; 101 controls and nine cases underwent fMCG only. AV and PR intervals increased with GA (P < 0.05 for both). Overall, AV and PR intervals were significantly different from each other (P < 0.001); this difference was not significant when compared between cases and controls (P = 0.222). PR interval could not be predicted accurately from AV interval and GA alone. Three of four cases with AV and PR interval Z-scores > + 3 had postnatal AVB-I despite treatment. The fourth fetus, which had predominately second-degree AVB and rare periods of AVB-I, progressed to third-degree AVB despite treatment with dexamethasone.
The diagnostic threshold for AVB-I, defined by AV interval Z-score, is GA dependent. Based on the observed data, an AV interval Z-score threshold of 3 (AV interval, 151-167 ms) may be appropriate. Echocardiographic AV interval was not predictive of fMCG-PR interval. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
本研究的目的首先是评估正常妊娠和抗 Ro/SSA 抗体阳性妊娠中胎儿超声心动图房室（AV）和磁心电图（fMCG）PR 间期与不同胎龄（GA）的相关性；其次，确定 PR 间期是否可以由 AV 间期预测；第三，评估 AV 和 PR 间期延长的胎儿的新生儿结局，旨在为胎儿一度房室传导阻滞（AVB-I）制定标准。
这是一项抗 Ro/SSA 抗体阳性妊娠（病例）和对照组的回顾性研究，这些病例和对照组在同一记录时段接受了 fMCG 和胎儿超声心动图检查。测量心动周期长度、GA 和 AV（通过二尖瓣血流/主动脉瓣流出多普勒）和 PR（通过 fMCG）间期。我们使用广义估计方程来检验 AV 和 PR 间期之间的显著差异，以解释重复测量，并评估 PR 间期是否可以由 AV 间期可靠地预测。分娩后，AV 或 PR 间期 Z 评分≥3 的婴儿接受 12 导联心电图检查。
39 名对照者和 31 名病例者分别接受了 46 次和 36 次同步 fMCG 和超声心动图检查；101 名对照者和 9 名病例者仅接受了 fMCG 检查。AV 和 PR 间期随 GA 增加（均 P<0.05）。总体而言，AV 和 PR 间期彼此之间存在显著差异（P<0.001）；但病例组和对照组之间的差异无统计学意义（P=0.222）。AV 间期和 GA 本身不能准确预测 PR 间期。尽管接受了治疗，4 例 AV 和 PR 间期 Z 评分>3 的病例中仍有 3 例出现新生儿 AVB-I。第四例胎儿主要表现为二度 AVB，偶尔出现一度 AVB-I，尽管接受了地塞米松治疗，仍进展为三度 AVB。
根据 AV 间期 Z 评分定义的 AVB-I 诊断阈值取决于 GA。根据观察数据，AV 间隔 Z 评分阈值为 3（AV 间隔，151-167ms）可能是合适的。超声心动图 AV 间隔不能预测 fMCG-PR 间期。版权所有©2019 ISUOG。由 John Wiley & Sons Ltd 出版。
