孕晚期低风险胎儿左右心室大小及收缩功能的比较：哪一个更占优势？
Comparison of the left and right ventricular size and systolic function of low-risk fetuses in the third trimester: Which is more dominant?
作者信息
Zhu Chen, Li Man, Xu Cheng-Jie, Ding Meng-Juan, Xiong Yu, Liu Rui, Ren Yun-Yun
机构信息
Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Information Technology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
出版信息
Front Cardiovasc Med. 2023 Mar 17;10:1052178. doi: 10.3389/fcvm.2023.1052178. eCollection 2023.
OBJECTIVE
To quantify fetal cardiovascular parameters utilizing fetal-specific 2D speckle tracking technique and to explore the differences in size and systolic function of the left and right ventricles in low-risk pregnancy.
METHODS
A prospective cohort study was performed in 453 low-risk single fetuses (28-39 weeks) to evaluate ventricular size [i.e., end-diastolic length (EDL), end-systolic length (ESL), end-diastolic diameter (ED), end-systolic diameter (ES), end-diastolic area, end-systolic area, end-diastolic volume (EDV), and end-systolic volume (ESV)] and systolic function [i.e., ejection fraction (EF), stroke volume (SV), cardiac output (CO), cardiac output per kilogram (CO/KG), and stroke volume per kilogram (SV/KG)].
RESULTS
This study showed that (1) the reproducibility of the interobserver and intraobserver measurements was good to excellent (ICC 0.626-0.936); (2) with advancing gestation, fetal ventricular size and systolic function increased, whereas right ventricular (RV) EF decreased and left ventricular (LV) EF was not significantly changed; (3) LV length was longer than RV length in diastole (2.24 vs. 1.96 cm, < 0.001) and systole (1.72 vs. 1.52 cm, < 0.001); (4) LV ED-S1 and ES-S1 were shorter than the RV ED-S1 and ES-S1 (12.87 vs. 13.43 mm, < 0.001; 5.09 vs. 5.61 mm, < 0.001); (5) there were no differences between the LV and RV in EDA or EDV; (6) the mean EDV ratio of right-to-left ventricle was 1.076 (95% CI, 1.038-1.114), and the mean ESV ratio was 1.628 (95% CI, 1.555-1.701); (7) the EF, CO and SV of the LV were greater than the RV (EF: 62.69% vs. 46.09%, < 0.001; CO: 167.85 vs. 128.69 ml, < 0.001; SV: 1.18 vs. 0.88 ml, < 0.001); (8) SV and CO increased with ED-S1 and EDL, but EF was not significantly changed.
CONCLUSION
Low-risk fetal cardiovascular physiology is characterized by a larger RV volume (especially after 32 weeks) and greater LV outputs (EF, CO, SV, SV/KG and CO/KG).
目的
利用胎儿特异性二维斑点追踪技术量化胎儿心血管参数，并探讨低风险妊娠中左右心室大小和收缩功能的差异。
方法
对453例低风险单胎胎儿（28 - 39周）进行前瞻性队列研究，以评估心室大小[即舒张末期长度（EDL）、收缩末期长度（ESL）、舒张末期直径（ED）、收缩末期直径（ES）、舒张末期面积、收缩末期面积、舒张末期容积（EDV）和收缩末期容积（ESV）]和收缩功能[即射血分数（EF）、每搏输出量（SV）、心输出量（CO）、每千克心输出量（CO/KG）和每千克每搏输出量（SV/KG）]。
结果
本研究表明：（1）观察者间和观察者内测量的重复性良好至优秀（组内相关系数ICC为0.626 - 0.936）；（2）随着孕周增加，胎儿心室大小和收缩功能增加，而右心室（RV）EF降低，左心室（LV）EF无显著变化；（3）舒张期LV长度长于RV长度（2.24 vs. 1.96 cm，<0.001），收缩期亦然（1.72 vs. 1.52 cm，<0.001）；（4）LV的ED - S1和ES - S1短于RV的ED - S1和ES - S1（12.87 vs. 13.43 mm，<0.001；5.09 vs. 5.61 mm，<0.001）；（5）LV和RV在舒张末期面积（EDA）或舒张末期容积（EDV）方面无差异；（6）右心室与左心室舒张末期容积的平均比值为1.076（95%可信区间，1.038 - 1.114），收缩末期容积的平均比值为1.628（95%可信区间，1.555 - 1.701）；（7）LV的EF、CO和SV大于RV（EF：62.69% vs. 46.09%，<0.001；CO：167.85 vs. 128.69 ml，<0.001；SV：1.18 vs. 0.88 ml，<0.001）；（8）SV和CO随ED - S1和EDL增加，但EF无显著变化。
结论
低风险胎儿心血管生理的特征是右心室容积较大（尤其是32周后），左心室输出量较大（EF、CO、SV、SV/KG和CO/KG）。
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