Jung Youn-Joon, Lee Bo-Ra, Kim Gwang Jun
Department of Obstetrics and Gynecology, School of Medicine, Chung-Ang University, Seoul, Korea.
Obstet Gynecol Sci. 2020 May;63(3):278-285. doi: 10.5468/ogs.2020.63.3.278. Epub 2020 Apr 7.
To prove the efficacy of determining the abnormal fetal cardiac axis for screening congenital heart defects (CHDs) and predicting fetal aneuploidy at 11.0 to 13.6 weeks of pregnancy.
This retrospective study was performed at a single high-risk pregnancy center. The fetal cardiac axis was evaluated between 11.0 and 13.6 weeks of gestation in 142 fetuses. The cardiac axis in a 4-chamber view was measured as the angle between the line tracing the long axis of the heart and the line bisecting the thorax in the anteroposterior direction. A CHD was confirmed based on the second- to third-trimester fetal status or postnatal imaging. Aneuploidy was diagnosed using chorionic villus sampling, amniocentesis, or genetic testing after birth. Fisher's exact test was performed to assess the association between the fetal cardiac axis and the abnormal fetal status. A 2-way contingence table analysis was performed to confirm the efficacy of the fetal cardiac axis as a screening tool.
Among the 142 fetuses, 10 had a CHD while 17 had aneuploidy. The abnormal fetal cardiac axis was significantly associated with CHDs (=0.013) and aneuploidy (=0.010). None of the fetuses with CHDs or aneuploidy had an isolated abnormal cardiac axis alone without other sonographic findings. The sensitivity of the fetal cardiac axis was 50.0% for CHDs and 41.2% for aneuploidy.
The fetal cardiac axis can be an additional helpful tool for prenatal screening of CHDs and aneuploidy in the first trimester.
证实妊娠11.0至13.6周时测定胎儿心脏轴异常对筛查先天性心脏病（CHD）及预测胎儿非整倍体的有效性。
本回顾性研究在一家高危妊娠中心进行。对142例妊娠11.0至13.6周的胎儿评估其心脏轴。在四腔心切面中，将追踪心脏长轴的线与在前后方向平分胸部的线之间的夹角作为心脏轴进行测量。根据孕中期至孕晚期胎儿情况或产后影像学检查确诊CHD。通过绒毛取样、羊膜穿刺术或出生后基因检测诊断非整倍体。采用Fisher精确检验评估胎儿心脏轴与胎儿异常状态之间的关联。进行双向列联表分析以确认胎儿心脏轴作为筛查工具的有效性。
142例胎儿中，10例患有CHD，17例患有非整倍体。胎儿心脏轴异常与CHD（P = 0.013）和非整倍体（P = 0.010）显著相关。患有CHD或非整倍体的胎儿均无单独孤立的异常心脏轴而无其他超声检查结果。胎儿心脏轴对CHD的敏感性为50.0%，对非整倍体的敏感性为41.2%。
胎儿心脏轴可作为孕早期产前筛查CHD和非整倍体的一种辅助有用工具。
