DeVore Greggory R, Putra Manesha, Hobbins John C
Fetal Diagnostic Centers, Pasadena, California, USA.
Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA.
J Ultrasound Med. 2025 May;44(5):831-843. doi: 10.1002/jum.16642. Epub 2025 Jan 9.
The size, shape, and contractility of the heart's atrial chambers have not been evaluated in fetuses with growth restriction (FGR) or who are small-for-gestational-age (SGA) as defined by the Delphi consensus protocol. This study aimed to examine the atrial chambers using speckle tracking analysis to identify any changes that may be specific for either growth disturbance.
Sixty-three fetuses were evaluated with an estimated fetal weight <10th percentile who were classified as FGR or SGA based on the Delphi consensus protocol. The atrial cardiac cycle was defined as end-diastole, end-systole, and end-diastole, equivalent to ventricular end-systole, end-diastole, and end-systole. The atrial size, shape, and contractility were computed from 24 transverse segments and one length measurement identified from speckle tracking analysis of the endocardium at end-diastole and end-systole. The z-score for each atrial measurement was computed using the mean and standard deviation equations from a control group of 200 fetuses. The z-score values were compared between the control and FGR/SGA fetuses as well as between FGR and SGA fetuses using the Kruskal-Wallis test. A P-value of <.05 was considered significant.
Of the 63 fetuses with an estimated fetal weight (EFW) <10th percentile, 60% (38/63) were classified as FGR and 40% (25/63) as SGA. The following abnormal atrial measurements were unique to FGR fetuses: decreased end-diastolic left atrial (LA) area, decreased LA base and mid-chamber end-diastolic width, decreased LA base sphericity index, decreased right atrial (RA) mid-chamber sphericity index, decreased LA ejection volume, and decreased LA emptying volume. The following were unique to the SGA fetuses: Increased RA mid-chamber length, decreased LA fractional area change, decreased RA reservoir strain, decreased RA basal-apical length fractional shortening, and decreased LA base width transverse fractional shortening. The significant difference was an increased LA mid-chamber length in the SGA fetuses.
Fetuses with an EFW <10th percentile who are classified as either SGA or FGR demonstrate unique abnormalities of atrial size, shape, and contractility, thus allowing the examiner to differentiate between FGR and SGA fetuses.
尚未按照德尔菲共识协议所定义的标准，对生长受限（FGR）或小于胎龄（SGA）胎儿的心房大小、形状及收缩性进行评估。本研究旨在使用斑点追踪分析来检查心房，以确定可能是生长障碍所特有的任何变化。
对63例估计胎儿体重低于第10百分位数的胎儿进行评估，根据德尔菲共识协议将其分类为FGR或SGA。心房心动周期定义为舒张末期、收缩末期和舒张末期，等同于心室收缩末期、舒张末期和收缩末期。心房大小、形状和收缩性由24个横向节段以及从舒张末期和收缩末期心内膜的斑点追踪分析确定的一个长度测量值计算得出。使用来自200例胎儿的对照组的均值和标准差方程计算每个心房测量值的z分数。使用Kruskal-Wallis检验比较对照组与FGR/SGA胎儿之间以及FGR与SGA胎儿之间的z分数值。P值<.05被认为具有统计学意义。
在63例估计胎儿体重（EFW）低于第10百分位数的胎儿中，60%（38/63）被分类为FGR，40%（25/63）被分类为SGA。以下心房测量异常是FGR胎儿所特有的：舒张末期左心房（LA）面积减小、LA基部和中部腔室舒张末期宽度减小、LA基部球形指数减小、右心房（RA）中部腔室球形指数减小、LA射血容积减小以及LA排空容积减小。以下是SGA胎儿所特有的：RA中部腔室长度增加、LA面积变化分数减小、RA储存应变减小、RA基部-顶部长度分数缩短减小以及LA基部宽度横向分数缩短减小。显著差异是SGA胎儿的LA中部腔室长度增加。
估计胎儿体重低于第10百分位数且被分类为SGA或FGR的胎儿表现出心房大小、形状和收缩性的独特异常，从而使检查者能够区分FGR和SGA胎儿。
