Ma Jing, Li Yuman, Cao Haiyan, Yuan Yaping, Chen Shizhen, Hong Liu, Zhang Li, Zhou Xin, Xie Mingxing
Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences - Wuhan National Laboratory for Optoelectronics, Wuhan, China; University of Chinese Academy of Sciences, Beijing, China.
Can J Cardiol. 2025 May;41(5):973-985. doi: 10.1016/j.cjca.2024.12.020. Epub 2024 Dec 18.
In this study we evaluated changes in left ventricular (LV) function and myocardial microstructure in fetuses with right ventricular hypoplasia (RVH) using 2-dimensional speckle tracking echocardiography, diffusion tensor cardiovascular magnetic resonance imaging, and proteomics analysis.
Fifty-one singleton fetuses diagnosed with RVH and 51 normal fetuses were retrospectively included. LV global longitudinal strain and global circumferential strain were acquired using 2-dimensional speckle tracking echocardiography. Fraction anisotropy, mean diffusivity, and helix angle were measured using diffusion tensor cardiovascular magnetic resonance imaging in 4 fetal specimens with RVH and 3 normal fetal specimens. Bioinformatics analysis was performed for differentially expressed proteins between RVH and normal specimens.
In RVH fetuses, LV global longitudinal strain and regional longitudinal strain were significantly lower than in controls (P < 0.001), whereas LV sphericity index and LV global circumferential strain were increased. In RVH fetuses, fraction anisotropy was higher in middle and apical segments than in normal fetuses (P < 0.001). LV mean diffusivity was reduced in all of the segments (P < 0.001). Circumferentially oriented myocytes and left-handed oriented myocytes were increased, but right-handed oriented myocytes were decreased (P < 0.001). Using proteomics, 95 myocardial proteins differed with upregulation of 66 and downregulation in RVH hearts including myocardial contractile fibrillar proteins and cell membrane protein complexes.
In fetal RVH, the left ventricle demonstrates altered function with reduced longitudinal but augmented circumferential strain, which might support its need to augment its preload and consequent cardiac output. Decreased right-handed and increased circumferentially oriented myocytes might contribute to this adaptation. The left ventricle in fetal RVH also demonstrates a differential expression of various myocardial proteins.
在本研究中，我们使用二维斑点追踪超声心动图、扩散张量心血管磁共振成像和蛋白质组学分析，评估了右心室发育不全（RVH）胎儿的左心室（LV）功能和心肌微观结构的变化。
回顾性纳入51例诊断为RVH的单胎胎儿和51例正常胎儿。使用二维斑点追踪超声心动图获取左心室整体纵向应变和整体圆周应变。在4例RVH胎儿标本和3例正常胎儿标本中，使用扩散张量心血管磁共振成像测量各向异性分数、平均扩散率和螺旋角。对RVH标本和正常标本之间差异表达的蛋白质进行生物信息学分析。
在RVH胎儿中，左心室整体纵向应变和区域纵向应变显著低于对照组（P<0.001），而左心室球形指数和左心室整体圆周应变增加。在RVH胎儿中，中段和心尖段的各向异性分数高于正常胎儿（P<0.001）。所有节段的左心室平均扩散率均降低（P<0.001）。圆周取向的心肌细胞和左旋取向的心肌细胞增加，但右旋取向的心肌细胞减少（P<0.001）。使用蛋白质组学，95种心肌蛋白存在差异，其中66种在RVH心脏中上调，29种下调，包括心肌收缩纤维蛋白和细胞膜蛋白复合物。
在胎儿RVH中，左心室功能发生改变，纵向应变降低但圆周应变增加，这可能支持其增加前负荷和随之的心输出量的需求。右旋心肌细胞减少和圆周取向心肌细胞增加可能有助于这种适应。胎儿RVH中的左心室还表现出各种心肌蛋白的差异表达。
