DeVore Greggory R, Afshar Yalda, Harake Danielle, Satou Gary, Sklansky Mark
Fetal Diagnostic Centers, Pasadena, California, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
J Ultrasound Med. 2022 Dec;41(12):2955-2964. doi: 10.1002/jum.15987. Epub 2022 Apr 9.
This study examines fetuses with tetralogy of Fallot (TOF) and evaluates the right (RV) and left (LV) ventricular contractility and LV function using speckle-tracking analysis of the endocardium.
The study group consisted of 44 fetuses with TOF, of which 34% had pulmonary valve atresia (N = 15) and 59% (N = 26) had pulmonary valve stenosis. The RV and LV global fractional area change, longitudinal contractility (longitudinal strain, free wall strain, septal strain, free wall and septal annular fractional shortening, and free wall and septal wall annular plane systolic excursion), and transverse contractility (24-segment fractional shortening) as well as LV functional assessment (stroke volume, cardiac output, and ejection fraction) were measured using speckle-tracking analysis. The z-scores of the measurements were compared to 200 controls.
Compared to controls, measurements of LV contractility in fetuses with TOF demonstrated significantly abnormal values for global contractility, longitudinal contractility, and transverse contractility of the mid and apical segments. LV function was abnormal for stroke volume (SV), cardiac output (CO), and ejection fraction (EF). In comparison, RV contractility demonstrated no significant difference between TOF and control z-score values for RV global contractility. Only two RV measurements were found to be abnormal: longitudinal contractility and transverse contractility of the apical segments.
Using multiple measurement tools to evaluate global, longitudinal, and transverse contractility, this study identified significant differences between fetuses with TOF and healthy controls, with greater contractility abnormalities seen in the LV than in the RV.
本研究对法洛四联症（TOF）胎儿进行检查，并采用心内膜斑点追踪分析评估右心室（RV）和左心室（LV）的收缩性以及左心室功能。
研究组由44例TOF胎儿组成，其中34%（n = 15）合并肺动脉瓣闭锁，59%（n = 26）合并肺动脉瓣狭窄。采用斑点追踪分析测量右心室和左心室的整体面积变化分数、纵向收缩性（纵向应变、游离壁应变、室间隔应变、游离壁和室间隔环形缩短分数，以及游离壁和室间隔环形平面收缩期偏移）、横向收缩性（24节段缩短分数）以及左心室功能评估指标（每搏输出量、心输出量和射血分数）。将测量的z值与200例对照进行比较。
与对照组相比，TOF胎儿左心室收缩性测量显示，中段和心尖段的整体收缩性、纵向收缩性和横向收缩性值明显异常。左心室功能在每搏输出量（SV）、心输出量（CO）和射血分数（EF）方面均异常。相比之下，右心室收缩性在右心室整体收缩性的TOF与对照z值之间无显著差异。仅发现两项右心室测量值异常：心尖段的纵向收缩性和横向收缩性。
本研究使用多种测量工具评估整体、纵向和横向收缩性，发现TOF胎儿与健康对照组之间存在显著差异，左心室的收缩性异常比右心室更明显。
