University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
J Ultrasound Med. 2024 Nov;43(11):2069-2084. doi: 10.1002/jum.16536. Epub 2024 Jul 30.
In a cohort of patients with estimated fetal weights (EFWs) <10th centile, we aimed 1) to compare the prevalence of abnormalities of fetal 4-chamber view (4CV) cardiac size, shape, and ventricular contractility in fetal growth restricted (FGR) and small-for-gestational-age (SGA) fetuses and 2) to compare umbilical vein flow (UVF) measurements to standard Doppler surveillance in predicting abnormalities of cardiac function.
Prospective observational cohort study of fetuses with EFW <10th percentile. Measurements of size and shape used were 4CV transverse width, 4CV cardiac area, 4CV global sphericity index, and right-to-left ventricular mid-chamber width ratio. Variables of contractility used were fractional shortening change at the mid-ventricle chamber, global longitudinal strain, fractional area change, and left ventricular cardiac output. The UVF and standard Doppler surveillance including umbilical artery (UA), middle cerebral artery, and cerebroplacental ratio (CPR) were collected. Control data were from previously published studies.
A total of 95 fetuses with EFWs <10th centile were included in the study. The rates of abnormalities of cardiac size and shape and ventricular contractility were all significantly elevated compared with normally grown control fetuses but similar between FGR and SGA fetuses. In a subset of 76 patients with UVF data, evaluation UVF identified more patients with any abnormality of contractility compared with UA (37.9 vs 17.2%, P = .02).
The addition of UVF doubled the detection rate of ventricular contractility abnormalities. The addition of UVF should be considered in the surveillance of FGR and SGA fetuses to further stratify the severity of hypoxemia and to identify those at greater risk for future cardiovascular dysfunction.
在估计胎儿体重（EFW）<第 10 百分位数的患者队列中，我们旨在 1）比较胎儿生长受限（FGR）和小于胎龄儿（SGA）胎儿的胎儿 4 腔心视图（4CV）心脏大小、形状和心室收缩力异常的发生率，2）比较脐静脉血流（UVF）测量值与标准多普勒监测在预测心脏功能异常方面的作用。
前瞻性观察性研究 EFW<第 10 百分位数的胎儿。使用的大小和形状测量值为 4CV 横径、4CV 心腔面积、4CV 整体球形指数和右心室中室宽度比。使用的收缩力变量为心室中部的分数缩短变化、整体纵向应变、分数面积变化和左心室心输出量。收集了 UVF 和标准多普勒监测值，包括脐动脉（UA）、大脑中动脉和脑胎盘比（CPR）。对照数据来自先前发表的研究。
共纳入 95 例 EFW<第 10 百分位数的胎儿。与正常生长的对照胎儿相比，心脏大小和形状以及心室收缩力异常的发生率均显著升高，但 FGR 和 SGA 胎儿之间无差异。在有 UVF 数据的 76 例患者亚组中，与 UA 相比，评估 UVF 发现更多患者存在收缩力异常（37.9%比 17.2%，P=0.02）。
添加 UVF 将心室收缩力异常的检测率提高了一倍。在 FGR 和 SGA 胎儿的监测中应考虑添加 UVF，以进一步分层缺氧的严重程度，并识别那些未来发生心血管功能障碍风险较高的患者。
