Lin Shan, Cao Haiyan, Hong Liu, Song Xiaoyan, Liu Kun, Xie Mingxing, Yang Yali
Department of Ultrasound, Hubei No. 3 People's Hospital of Jianghan University, Wuhan, China.
Department of Ultrasound, Tongji Medical College, Union Hospital, University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2023 Jan 10;9:973395. doi: 10.3389/fcvm.2022.973395. eCollection 2022.
The aim of this study was to evaluate right ventricular (RV) systolic function in fetuses with transposition of the great arteries (TGA) using velocity vector imaging (VVI) and to investigate the impact of different factors on RV systolic function in TGA fetuses.
This was a retrospective cross-sectional study of fetuses referred to our tertiary center between 2015 and 2019. Maternal and fetal baseline characteristics and conventional echocardiographic and myocardial deformation indices were collected in fetuses with TGA at 20-28 weeks' gestation, which were compared with normal fetuses with comparable gestational age (GA). RV deformational parameters including global and regional longitudinal peak systolic strain, strain rate, and velocity were measured using off-line speckle tracking analysis. The univariate and multivariate linear regression analyses were established to evaluate the independent risk factors for RV global longitudinal systolic strain (RVGLSs) and strain rate (RVGLSRs).
In total, 78 fetuses with TGA [including 49 fetuses with complete transposition of the great arteries (d-TGA) and 29 fetuses with Taussig-Bing anomaly (TBA)] and 49 normal fetuses were included. Compared with normal controls, global and most regional RV longitudinal systolic peak velocity, strain, and strain rate were lower in d-TGA and TBA fetuses ( < 0.05). Compared with normal controls, global and most regional RV longitudinal systolic strain was lower in d-TGA fetuses without pulmonary stenosis (PS) and ventricular septal defect (VSD), while RVGLSs and RVGLSRs were lower in TBA fetuses without PS. The VSD was an independent determinant of RVGLSRs ( = 0.024) in the d-TGA group. Additionally, PS was an independent determinant of RVGLSs and RVGLSRs ( = 0.012, = 0.027) in the TBA group.
Early impairment of RV systolic function has already occurred in TGA fetuses during the 2nd trimester of pregnancy. PS, VSD, and foramen ovale (FO) were independent risk factors for decreased RV function.
本研究旨在利用速度向量成像（VVI）评估大动脉转位（TGA）胎儿的右心室（RV）收缩功能，并探讨不同因素对TGA胎儿RV收缩功能的影响。
这是一项对2015年至2019年间转诊至我们三级中心的胎儿进行的回顾性横断面研究。收集妊娠20 - 28周的TGA胎儿的母体和胎儿基线特征以及常规超声心动图和心肌变形指标，并与孕周相当的正常胎儿进行比较。使用离线斑点追踪分析测量RV变形参数，包括整体和局部纵向收缩期峰值应变、应变率和速度。建立单变量和多变量线性回归分析以评估RV整体纵向收缩期应变（RVGLSs）和应变率（RVGLSRs）的独立危险因素。
共纳入78例TGA胎儿[包括49例完全性大动脉转位（d-TGA）胎儿和29例陶西格-宾畸形（TBA）胎儿]以及49例正常胎儿。与正常对照组相比，d-TGA和TBA胎儿的整体及大多数局部RV纵向收缩期峰值速度、应变和应变率较低（<0.05）。与正常对照组相比，无肺动脉狭窄（PS）和室间隔缺损（VSD）的d-TGA胎儿的整体及大多数局部RV纵向收缩期应变较低，而无PS的TBA胎儿的RVGLSs和RVGLSRs较低。VSD是d-TGA组中RVGLSRs的独立决定因素（=0.024）。此外，PS是TBA组中RVGLSs和RVGLSRs的独立决定因素（=0.012，=0.027）。
妊娠中期TGA胎儿已出现RV收缩功能的早期损害。PS、VSD和卵圆孔（FO）是RV功能降低的独立危险因素。
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