Fuwai Yunnan Cardiovascular Hospital, Yunnan, China.
The Cleveland Clinic Foundation, Cleveland, OH, USA.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2214663. doi: 10.1080/14767058.2023.2214663.
To study myocardial deformation in fetuses with ventricular afterload increase compared with gestational age-matched controls using speckle tracking echocardiography.
Eighty-nine fetuses were retrospectively selected from the pregnancy screen by echocardiography. There are 41 fetuses with gestational age-matched normal heart served as the control group, 25 fetuses with congenital heart disease (CHD) leading to left ventricular (LV) afterload increase as group LVA and 23 fetuses with CHD leading to right ventricular(RV) afterload increases as group RVA. LV and RV fractional shortening (FS) were measured by conventional methods. The longitudinal strain (LS) and strain rate (LSr) were analyzed by EchoPac software. Group LVA and RVA compared with control group, the LV FS was no significant difference, but LS and LSr values of LV were lower in fetuses with LVA compared to the control group (LS:-15.97(-12.50,-22.52)vs -27.53(-24.33,-29.16) %, < .01; systolic strain rate (SRs):-1.34(-1.12,-2.16) vs -2.55(-2.28,-2.92) 1/sec, < .01; early diastolic strain rate (SRe):1.70 ± 0.57 vs 2.46 ± 0.61 1/sec, < 0.01; late diastolic strain rate (SRa):1.62 ± 0.82 vs 2.39 ± 0.81 1/sec, < .01). LS and LSr values of LV or RV were lower in fetuses with RVA compared to the control group (LV: LS:-21.52 ± 6.68 vs -26.79 ± 3.22%, < .01; SRs:-2.11 ± 0.78 vs -2.56 ± 0.43 1/sec; = .02; RV: LS:-17.64 ± 7.58 vs -26.38 ± 3.97%, < .01; SRs:-1.62 ± 0.67 vs -2.37 ± 0.44 1/sec; < .01).
The results of this study showed that the ventricular LS, LSr, SRs, SRe, SRa values were lower in fetuses with LV or RV afterload increasing CHD estimated by speckle tracking imaging but LV and RV FS were normal,which indicated the strain imaging is feasible in evaluating cardiac function of fetus, and may be more sensitive.
应用斑点追踪超声心动图技术研究心室后负荷增加的胎儿与胎龄匹配对照组之间的心肌变形。
通过超声心动图从妊娠筛查中回顾性选择了 89 例胎儿。其中 41 例胎龄匹配的正常心脏胎儿作为对照组，25 例先天性心脏病（CHD）导致左心室（LV）后负荷增加的胎儿为 LVA 组，23 例 CHD 导致右心室（RV）后负荷增加的胎儿为 RVA 组。采用常规方法测量左心室和右心室的缩短分数（FS）。采用 EchoPac 软件分析左心室和右心室的纵向应变（LS）和应变率（LSr）。与对照组相比，LVA 组和 RVA 组的左心室 FS 无显著差异，但 LVA 组的左心室 LS 和 LSr 值低于对照组（LS：-15.97（-12.50，-22.52）vs -27.53（-24.33，-29.16）%，<0.01；收缩期应变率（SRs）：-1.34（-1.12，-2.16）vs -2.55（-2.28，-2.92）1/sec，<0.01；早期舒张应变率（SRe）：1.70±0.57 vs 2.46±0.61 1/sec，<0.01；晚期舒张应变率（SRa）：1.62±0.82 vs 2.39±0.81 1/sec，<0.01）。与对照组相比，RVA 组的左心室或右心室的 LS 和 LSr 值均较低（LV：LS：-21.52±6.68 vs -26.79±3.22%，<0.01；SRs：-2.11±0.78 vs -2.56±0.43 1/sec；=0.02；RV：LS：-17.64±7.58 vs -26.38±3.97%，<0.01；SRs：-1.62±0.67 vs -2.37±0.44 1/sec；<0.01）。
本研究结果表明，通过斑点追踪成像技术评估左心室或右心室后负荷增加的 CHD 胎儿，心室 LS、LSr、SRs、SRe、SRa 值降低，但左心室和右心室 FS 正常，表明应变成像在评估胎儿心功能方面是可行的，且可能更敏感。
