Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5872-5880. doi: 10.1080/14767058.2021.1900102. Epub 2021 Mar 11.
The aim of this study was to assess the characteristics of mitral annular plane systolic excursion (MAPSE) in different longitudinal directions in normal fetuses using a new method, automatic cardiac motion quantification (aCMQ).
A cross-sectional study was conducted in 164 fetuses with structurally normal hearts. The time-displacement curves of the septal mitral annulus (SMA) in three directions, including point A, B and C (MAPSE-SMA-A, MAPSE-SMA-B, MAPSE-SMA-C), were recorded by aCMQ. The time to peak (TTP) in three directions, including point A, B and C (TTP-SMA-A, TTP-SMA-B, TTP-SMA-C) were recorded. In the same way, various parameters of the lateral mitral annulus (LMA) were obtained including MAPSE-LMA-A, MAPSE-LMA-B, MAPSE-LMA-C, TTP-LMA-A, TTP-LMA-B and TTP-LMA-C. Free angle M-mode echocardiography (FAM) was used to obtain MAPSE of LMA (FAM-MAPSE). Finally, all the data were analyzed statistically.
MAPSE was positively correlated with gestational age, and the difference between the second- and third-trimester groups was statistically significant. MAPSE-LMA in point B and C were greater than those of SMA. MAPSE-LMA-C and MAPSE-SMA-A were the largest in three directions.The difference between point B and C were statistically significant ( .05), with no significant difference at point A ( > .05). There was no significant difference found in all TTP (all > .05). The MAPSE-LMA-C was less than the FAM-MAPSE, and the differences were found significantly ( < .05), but there was better correlation ( < .05).
The longitudinal movement of the fetal mitral annulus is comprehensive, with multiple directions and different displacements. Perpendicular to the mitral annulus is the maximum displacement. It is positively related to the gestational age. From the second trimester, the longitudinal contraction of the left ventricle wall has good synchronization. It possesses clinical value in selecting different methods and parameters during evaluating left ventricular function.
本研究旨在应用自动心脏运动定量（aCMQ）新技术评估正常胎儿不同纵向方向的二尖瓣环平面收缩期位移（MAPSE）的特征。
对 164 例结构正常的胎儿进行横断面研究。通过 aCMQ 记录二尖瓣环间隔部（SMA）三个方向（A、B 和 C 点）的时移曲线（MAPSE-SMA-A、MAPSE-SMA-B、MAPSE-SMA-C），记录三个方向（A、B 和 C 点）的达峰时间（TTP）（TTP-SMA-A、TTP-SMA-B、TTP-SMA-C）。同样，获得外侧二尖瓣环（LMA）的各种参数，包括 MAPSE-LMA-A、MAPSE-LMA-B、MAPSE-LMA-C、TTP-LMA-A、TTP-LMA-B 和 TTP-LMA-C。采用自由角度 M 型超声心动图（FAM）获得 LMA 的 MAPSE（FAM-MAPSE）。最后，对所有数据进行统计学分析。
MAPSE 与胎龄呈正相关，且二、三孕期组间差异有统计学意义。B 点和 C 点的 MAPSE-LMA 大于 SMA。三个方向中 MAPSE-LMA-C 和 MAPSE-SMA-A 最大。B 点和 C 点之间的差异有统计学意义（ .05），A 点之间差异无统计学意义（ > .05）。所有 TTP 之间差异均无统计学意义（均 > .05）。MAPSE-LMA-C 小于 FAM-MAPSE，差异有统计学意义（ < .05），但相关性更好（ < .05）。
胎儿二尖瓣环的纵向运动是全面的，具有多个方向和不同的位移。垂直于二尖瓣环的是最大位移。它与胎龄呈正相关。从孕中期开始，左心室壁的纵向收缩具有良好的同步性。在评估左心室功能时，选择不同方法和参数具有临床价值。
