胎儿生长障碍时改良的心肌做功指数作为辅助诊断和预后指标。
Modified Myocardial Performance Index in Fetal Growth Disturbances as Diagnostic and Prognostic Adjunct.
机构信息
Department of Pediatric Cardiology, Democracy University Faculty of Medicine, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Türkiye.
Department of Perinatology, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Türkiye.
出版信息
Anatol J Cardiol. 2023 Jan;27(1):34-40. doi: 10.14744/AnatolJCardiol.2022.2577.
BACKGROUND
Fetal growth disturbance can be associated with cardiac dysfunction. This study aimed to assess the modified myocardial performance index in growth-restricted and appropriate for gestational age fetuses and evaluate both its prognostic value in perinatal period and also its association with adverse perinatal outcomes.
METHODS
Totally 131 pregnant women were included in this prospective study. Of these, 56 cases were in study group with a diagnosis of small fetus and 75 cases were in control group with a diagnosis appropriately grown fetus. Fetal echocardiography was performed in all pregnant women to measure modified myocardial performance index. Umbilical, middle cerebral and uterine artery Doppler ultrasound parameters were measured in the study group. Small fetuses were categorized into 2 subgroups of late-onset fetal growth restriction and small for gestational age.
RESULTS
Modified myocardial performance index was significantly higher in small fetuses compared to controls (0.45 vs. 0.37, P <.001). Newborn intensive care unit admission rates were significantly higher in small fetuses than in controls (chi-square test, P <.001). The highest mean modified myocardial performance index was recorded in the late-onset fetal growth restriction subgroup (0.45 vs. 0.41 vs. 0.37). The sensitivity and specificity of modified myocardial performance index in predicting adverse outcomes at a cut-off value of 0.41 were 63% and 75%, respectively. There was a significant negative correlation between modified myocardial performance index values and birth weights.
CONCLUSIONS
We found higher left fetal heart modified myocardial performance index values in small fetuses indicating the presence of prenatal cardiac dysfunction. Fetal myocardial performance deteriorates in concordance with severity of growth restriction. Modified myocardial performance index can also be used to predict adverse perinatal outcomes among growth-restricted fetuses.
背景
胎儿生长障碍可伴有心功能障碍。本研究旨在评估生长受限和胎龄适当的胎儿的改良心肌做功指数，并评估其在围生期的预后价值及其与不良围生期结局的关系。
方法
本前瞻性研究共纳入 131 例孕妇。其中，56 例为研究组，诊断为胎儿生长受限，75 例为对照组，诊断为胎龄适当的胎儿。所有孕妇均行胎儿超声心动图检查，测量改良心肌做功指数。研究组测量脐动脉、大脑中动脉和子宫动脉多普勒超声参数。将生长受限胎儿分为晚发型胎儿生长受限和小于胎龄儿亚组。
结果
与对照组相比，生长受限胎儿的改良心肌做功指数明显升高（0.45 比 0.37，P<0.001）。生长受限胎儿的新生儿重症监护病房入住率明显高于对照组（卡方检验，P<0.001）。晚发型胎儿生长受限亚组的改良心肌做功指数平均值最高（0.45 比 0.41 比 0.37）。改良心肌做功指数的截断值为 0.41 时，预测不良结局的敏感性和特异性分别为 63%和 75%。改良心肌做功指数值与出生体重呈显著负相关。
结论
我们发现生长受限胎儿左心改良心肌做功指数较高，提示存在产前心功能障碍。胎儿心肌功能随生长受限的严重程度而恶化。改良心肌做功指数也可用于预测生长受限胎儿的不良围生期结局。
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