环状平面收缩期位移 Z 分数在评估心力衰竭胎儿心脏收缩功能中的应用。

Annular plane systolic excursion Z-scores in evaluation of heart systolic function of fetus with heart failure.

机构信息

Department of Diagnostic Ultrasound & Echocardiography, Pingyang Hospital Affiliated Wenzhou Medical University, Wenzhou, China.

Department of Anesthesia, Pingyang Hospital Affiliated Wenzhou Medical University, Wenzhou, China.

出版信息

J Matern Fetal Neonatal Med. 2022 Dec;35(25):5301-5307. doi: 10.1080/14767058.2021.1878492. Epub 2021 Jan 27.

DOI:10.1080/14767058.2021.1878492

PMID:33504233

Abstract

OBJECTIVE

To compare fetal tricuspid annular plane systolic excursion(TAPSE）Z-scores and mitral annular plane systolic excursion(MAPSE) Z-scores between fetuses with heart failure (HF) and normal fetuses, and to analysis the correlation between CVPS and annular plane systolic excursion(APSE) Z-score(sum of the TAPSE and MAPSE Z-score) in order to evaluate the ventricle systolic function and severity in fetuses with HF.

METHODS

A total of 1012 normal fetuses and 24 fetuses with heart failure were involved. TAPSE and MAPSE were measured by free angle M-mode(FAM) echocardiography. Normal FAM-TAPSE and FAM-MAPSE Z-score models based on GA were constructed by performing a standard regression analysis followed by weighted regression of absolute residual values . Tei indexes were calculated in all fetuses with heart failure and all of them were divided into left heart failure (LHF)group and right heart failure（RHF)group by Tei index. Subsequently, FAM-MAPSE Z-scores were compared between the normal and LHF groups, FAM-TAPSE Z-scores were compared between the normal and RHF groups．FAM-APSE Z-scores (sum of the FAM-TAPSE and FAM-MAPSE Z-score) and the cardiovascular profile scores (CVPS) in 24 fetuses were calculated, the correlation was analyzed among them.

RESULTS

The models used to calculate Z-score for FAM-TAPSE and FAM-MAPSE were constructed, and GA had significant correlation with them ( = 0.949, < 0.001for all)．Compared with normal fetuses, the mean Z-scores of FAM-TAPSE and FAM-MAPSE were statistically significantly different in fetuses with HF．In the HF groups, all FAM-TAPSE and FAM-MAPSE Z-scores(22/22) were <-2. CVPS ranged from 3 to 8 (mean 5.25 out of 10) and correlated positively with FAM-APSE Z-score ( = 0.762).

CONCLUSIONS

The FAM-TAPSE and FAM-MAPSE Z-scores declined in fetuses with HF and they can provide quantitative evidence in evaluation of heart systolic function, FAM-APSE Z-score correlated positively with CVPS. FAM-TAPSE, FAM-MAPSE and FAM-APSE Z-scores would be markers for assessing heart systolic function and severity in fetuses with HF.

摘要

目的

比较心力衰竭胎儿与正常胎儿的三尖瓣环平面收缩期位移（TAPSE）Z 评分和二尖瓣环平面收缩期位移（MAPSE）Z 评分，并分析心血管参数评分（CVPS）与瓣环平面收缩期位移（APSE）Z 评分（TAPSE 和 MAPSE Z 评分之和）之间的相关性，以评估心力衰竭胎儿的心室收缩功能和严重程度。

方法

纳入 1012 例正常胎儿和 24 例心力衰竭胎儿。采用自由角度 M 型超声心动图（FAM）测量 TAPSE 和 MAPSE。通过标准回归分析和绝对残差加权回归构建基于胎龄（GA）的正常 FAM-TAPSE 和 FAM-MAPSE Z 评分模型。计算所有心力衰竭胎儿的 Tei 指数，并根据 Tei 指数将其分为左心衰竭（LHF）组和右心衰竭（RHF）组。随后，比较正常组和 LHF 组之间的 FAM-MAPSE Z 评分，比较正常组和 RHF 组之间的 FAM-TAPSE Z 评分。计算 24 例胎儿的 FAM-APSE Z 评分（TAPSE 和 MAPSE Z 评分之和）和心血管参数评分（CVPS），并分析它们之间的相关性。

结果

构建了 FAM-TAPSE 和 FAM-MAPSE Z 评分的计算模型，GA 与它们具有显著相关性（ = 0.949，P<0.001）。与正常胎儿相比，心力衰竭胎儿的 FAM-TAPSE 和 FAM-MAPSE 平均 Z 评分均有统计学差异。在心力衰竭组中，所有 FAM-TAPSE 和 FAM-MAPSE Z 评分（22/22）均<-2。CVPS 范围为 3 至 8（平均 10 分中的 5.25 分），与 FAM-APSE Z 评分呈正相关（ = 0.762）。