Peixoto Alberto Borges, Bravo-Valenzuela Nathalie Jeanne, Martins Wellington P, Tonni Gabriele, Mattar Rosiane, Moron Antonio Fernandes, Pares David Baptista, Araujo Júnior Edward
Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba-MG, Brazil.
J Perinat Med. 2020 Jul 28;48(6):601-608. doi: 10.1515/jpm-2020-0002.
Objectives This study aimed to establish reference ranges for fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (MAPSE, TAPSE, and SAPSE) in normal pregnant women between 20 and 36 + 6 weeks of gestation. Methods This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. MAPSE, TAPSE, and SAPSE were measured by M-mode in real time in an apical or basal four-chamber view through placing the cursor at the atrioventricular junction, marked by the valve rings at the tricuspid, mitral, and basal septum, respectively. A regression analysis was done to determine the appropriate polynomial equation model for both measurements and standard deviation (SD) values in relation to gestational age (GA). The intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC) and limits of agreement (LoA). Results There was a significant positive correlation between MAPSE (r=0.705, p<0.0001), TAPSE (r=0.804, p<0.0001), and SAPSE (r=0.690, p<0.0001) and GA. The mean of each parameter ranged as follows: 2.87-5.56 mm, MAPSE; 3.98-8.07 mm, TAPSE; and 2.34-4.21 mm, SAPSE. Poor/moderate intra- and inter-observer reliability (CCC between 0.70 and 0.90) and poor/moderate agreement of all the tested parameters were evaluated (LoA between 10 and 50%). Conclusions Reference values were established for the fetal MAPSE, TAPSE, and SAPSE between 20 and 36 + 6 weeks of gestation in low-risk pregnant women. These parameters showed poor/moderate reproducibility.
目的 本研究旨在确定妊娠20至36⁺⁶周正常孕妇胎儿二尖瓣、三尖瓣及室间隔环平面收缩期偏移（MAPSE、TAPSE和SAPSE）的参考范围。方法 这项前瞻性横断面研究纳入了360例妊娠20至36⁺⁶周的低风险单胎妊娠。通过将光标置于房室交界处，分别以三尖瓣、二尖瓣和基底部间隔的瓣膜环为标记，在心尖或心底四腔视图中实时用M型测量MAPSE、TAPSE和SAPSE。进行回归分析以确定与胎龄（GA）相关的测量值和标准差（SD）值的合适多项式方程模型。使用一致性相关系数（CCC）和一致性界限（LoA）评估观察者内和观察者间的可重复性。结果 MAPSE（r = 0.705，p < 0.0001）、TAPSE（r = 0.804，p < 0.0001）和SAPSE（r = 0.690，p < 0.0001）与GA之间存在显著正相关。每个参数的平均值范围如下：MAPSE为2.87 - 5.56毫米；TAPSE为3.98 - 8.07毫米；SAPSE为2.34 - 4.21毫米。评估了观察者内和观察者间可靠性较差/中等（CCC在0.70至0.90之间）以及所有测试参数的一致性较差/中等（LoA在10%至50%之间）。结论 确定了妊娠20至36⁺⁶周低风险孕妇胎儿MAPSE、TAPSE和SAPSE的参考值。这些参数显示出较差/中等的可重复性。
