Hantrakun Panisa, Srisupundit Kasemsri, Tongsong Theera
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Fetal Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Diagnostics (Basel). 2025 Sep 11;15(18):2303. doi: 10.3390/diagnostics15182303.
To evaluate the diagnostic performance of CVPs in predicting fetal Hb Bart's disease among pregnancies at risk and to study hemodynamic changes based on CVP components in response to fetal anemia. The database was assessed to retrieve the ultrasound records of fetuses at risk of Hb Bart's disease at 17-22 weeks and the relevant files including complete video sets of fetal echocardiography. The five components of CVPs of each case were blindly assigned. The definitive diagnosis of fetal Hb Bart's disease was based on cordocentesis or neonatal blood analysis. Among 378 pregnancies at risk that were recruited into the study, there were 76 (20.1%) affected fetuses and 302 (79.9%) unaffected fetuses. Using a cut-off score of <9, CVPs had a sensitivity of 92.1% and specificity of 97.4% in predicting affected fetuses. However, the effectiveness was not much superior to cardio-thoracic area ratio (CTAR) alone (area under curve; AUC: 0.983 vs. 0.954). Of all parameters, CTAR provided the best diagnostic performance. The combination of CTAR and assessment of hydropic sign provided the best diagnostic values, comparable with full CVPs (AUC 0.982 vs. 0.983). The affected fetuses cope well with anemia by physically increasing in cardiac size and functionally increasing in Tei index with minimally reduced shortening fraction, without compromising arterial and venous Doppler indices. CVPs are highly effective in predicting affected fetuses among pregnancies at risk of fetal Hb Bart's disease. Nevertheless, only two components (CTAR and hydropic sign) are adequate to yield the best diagnostic performance.
评估中心静脉参数（CVPs）在预测高危妊娠中胎儿血红蛋白巴特氏病的诊断性能，并基于CVPs各组成部分研究胎儿贫血时的血流动力学变化。评估数据库以检索17 - 22周时患血红蛋白巴特氏病风险胎儿的超声记录以及包括完整胎儿超声心动图视频集的相关文件。对每个病例的CVPs五个组成部分进行盲法赋值。胎儿血红蛋白巴特氏病的确诊基于脐带穿刺或新生儿血液分析。在纳入研究的378例高危妊娠中，有76例（20.1%）为患病胎儿，302例（79.9%）为未患病胎儿。使用截断值<9时，CVPs在预测患病胎儿方面的敏感性为92.1%，特异性为97.4%。然而，其有效性并不比单独的心胸面积比（CTAR）高很多（曲线下面积；AUC：0.983对0.954）。在所有参数中，CTAR提供了最佳诊断性能。CTAR与水肿体征评估相结合提供了最佳诊断价值，与完整的CVPs相当（AUC 0.982对0.983）。患病胎儿通过心脏大小的生理性增加和Tei指数的功能性增加以及缩短分数的最小减少来很好地应对贫血，而不影响动脉和静脉多普勒指数。CVPs在预测胎儿血红蛋白巴特氏病高危妊娠中的患病胎儿方面非常有效。然而，仅两个组成部分（CTAR和水肿体征）就足以产生最佳诊断性能。
