Yakut Kadriye, Öcal Doğa Fatma, Sanhal Yaşar Cem, Halıcı Öztürk Filiz, Şanlı Cengiz, Çelen Şevki
Perinatology Department, Turkish Ministry of Health, Fethi Sekin City Hospital, Elazığ, Turkey.
Perinatology Department, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6946-6952. doi: 10.1080/14767058.2021.1931676. Epub 2021 May 31.
To investigate fetal epicardial fat thickness (EFT) value in fetal growth restriction (FGR) and its relationship with clinical parameters, fetal modified myocardial index (Mod-MPI), and the Doppler parameters.
Eighty-five pregnant women, with 30 diagnosed with FGR and 55 healthy pregnant women as control group participated in this prospective case-control study. FGR group was divided into 2 subgroups as early ( = 9) and late FGR ( = 21) groups. Demographic data were taken from the medical records. Amnion fluid value, fetal biometric measurements, and Doppler parameters were obtained. Fetal EFT and fetal Mod-MPI were measured by using the echocardiographic methods. The correlation tests were performed to assess the association between EFT and clinical and ultrasonographic parameters. < .05 was interpreted as statistically significant.
EFT value was found statistically lower in the early and late FGR groups than the control group ( = .003). Higher umbilical artery pulsatility index (PI) and lower cerebroplacental ratio (CPR) values were found in the early and late FGR ( < .001, = .001). The optimal EFT cutoff level to predict FGR disease was measured as 1.25 with 63.3% specificity and 77.4% sensitivity. Lower ejection time (ET) and higher Mod-MPI and isovolumetric contraction time (ICT) values were found in the group FGR with absent UAEDF than in the group FGR with no absent UAEDF ( = .001, < .000, < .000, respectively). Correlation tests showed statistically negative and weak correlations among EFT, umbilical artery PI, and mean Ut A-PI ( = .019, = .019). Positive correlations were found in regard to gestational age, EFW, and EFT ( = .002, < .000).
Our study showed that the measurement of EFT may contribute to predicting the diagnosis of FGR. Moreover, lower EFT values can be related to the severity of FGR. Future randomized control studies are needed to understand the effects and pathways of fetal EFT on fetal cardiac function.
探讨胎儿生长受限（FGR）时胎儿心包脂肪厚度（EFT）值及其与临床参数、胎儿改良心肌指数（Mod-MPI）和多普勒参数的关系。
85例孕妇参与了这项前瞻性病例对照研究，其中30例诊断为FGR，55例健康孕妇作为对照组。FGR组又分为早期FGR（n = 9）和晚期FGR（n = 21）两个亚组。人口统计学数据取自病历。获取羊水值、胎儿生物测量数据和多普勒参数。采用超声心动图方法测量胎儿EFT和胎儿Mod-MPI。进行相关性检验以评估EFT与临床及超声参数之间的关联。P < 0.05被认为具有统计学意义。
早期和晚期FGR组的EFT值在统计学上低于对照组（P = 0.003）。早期和晚期FGR组的脐动脉搏动指数（PI）较高，脑胎盘比率（CPR）值较低（P < 0.001，P = 0.001）。预测FGR疾病的最佳EFT截断水平为1.25，特异性为63.3%，敏感性为77.4%。与无脐动脉舒张末期血流缺失（UAEDF）的FGR组相比，有UAEDF的FGR组的射血时间（ET）较低，Mod-MPI和等容收缩时间（ICT）值较高（分别为P = 0.001，P < 0.000，P < 0.000）。相关性检验显示EFT、脐动脉PI和平均子宫动脉-胎盘PI之间存在统计学上的负相关且较弱（P = 0.019，P = 0.019）。在孕周、胎儿估计体重（EFW）和EFT之间发现正相关（P = 0.002，P < 0.000）。
我们的研究表明，EFT的测量可能有助于预测FGR的诊断。此外，较低的EFT值可能与FGR的严重程度有关。未来需要进行随机对照研究以了解胎儿EFT对胎儿心功能的影响及途径。
