超声心动图定量右心时间间期在评估右心室流出道梗阻性疾病胎儿右心功能中的应用研究  

Application of right heart time interval measured using echocardiography in evaluating right heart function in fetuses with right ventricular outflow tract obstruction

作　　者：冯敏 赵博文[1] 潘美[1] 彭晓慧[1] 陈冉[1] 毛彦恺[1] 陈阳 Min Feng;Bowen Zhao;Mei Pan;Xiaohui Peng;Ran Chen;Yankai Mao;Yang Chen(Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Technical Guidance Center for Fetal Echocardiography of Zhejiang Province&Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,Hangzhou 310016,China;Department of Ultrasonography,Affiliated Hangzhou First People's Hospital,School of Medicine,Westlake University,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科、浙江省胎儿心脏超声诊断技术指导中心、浙江大学邵逸夫临床医学研究所,杭州310016 [2]西湖大学附属杭州市第一人民医院超声科,杭州310016

出　　处：《中华医学超声杂志（电子版）》2024年第2期151-157,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：浙江大学科学技术研究院一般横向项目(校合-2021-KYY-518053-0055);浙江省基础公益研究计划项目(LGF20H180013)。

摘　　要：目的探讨胎儿超声心动图定量右心时间间期在右心室流出道梗阻性疾病(RVOTO)胎儿右心功能评估中的价值。方法这是一项前瞻性研究。纳入2021年2月至2022年8月在浙江大学医学院附属邵逸夫医院超声心动图诊断为RVOTO的胎儿28例(RVOTO组)及同期胎龄匹配的心脏超声检查未见明显异常的胎儿114例(正常组)。胎儿右心功能参数包括M型超声心动图测量三尖瓣环收缩期位移(TAPSE)、组织多普勒(TDI)获取三尖瓣环舒张期流速曲线并测量舒张早期速度(E')及舒张晚期速度(A'),并计算E'/A'值,同时测量右心等容收缩时间(ICT)、等容舒张时间(IRT)、充盈时间(FT)、射血时间(ET)及心动周期(CT),并通过公式计算胎儿右心的心肌做功指数(RVMPI)、收缩舒张时间指数(SDI)、收缩舒张持续时间比(SDR)、充盈时间分数(FTF)和射血时间分数(ETF)。比较2组间各超声心动图参数,分析其差异性。结果RVOTO组IRT平均值为(43.21±4.88)ms,低于正常组(45.71±5.12)ms;RVOTO组ICT平均值为(42.79±5.59)ms,低于正常组(47.82±7.09)ms;RVOTO组胎儿(ICT+IRT)平均值为(87.29±7.78)ms,低于正常组(93.51±10.48)ms;RVOTO组FT平均值为(124.46±4.70)ms,低于正常组(142.00±15.77)ms,以上参数2组间比较差异均有统计学意义(P均<0.05)。RVOTO组胎儿RVMPI指数大于正常组(0.52±0.06 vs 0.48±0.07,P<0.001),RVOTO组SDI大于正常组(2.17±0.18 vs 1.95±0.24,P<0.001),RVOTO组SDR大于正常组(1.35±0.12 vs 1.22±0.12,P<0.001),RVOTO组FTF小于正常组(0.31±0.02 vs 0.34±0.03,P<0.001),三尖瓣环E'值正常组大于RVOTO组(6.38±1.82 vs 5.59±1.96,P<0.001),三尖瓣环E'/A'值正常组大于RVOTO组(0.62±0.11 vs 0.51±0.12,P<0.001)。结论胎儿超声心动图定量右心室MPI、SDI、SDR、FTF及三尖瓣环E'值和E'/A'比值有助于对RVOTO胎儿的右心功能进行综合评价,对评估胎儿当前疾病状态及估测预后有潜在的临床应用价值。Objective To assess the value of right heart time interval measured by echocardiography in evaluating right heart function in fetuses with right ventricular outflow tract obstruction(RVOTO).Methods This prospective study included 28 fetuses diagnosed with RVOTO by echocardiography(RVOTO group)at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,and 114 fetuses matched for gestational age with no abnormalities(normal group).Right heart function parameters of all the fetuses were measured,including tricuspid annular plane systolic excursion(TAPSE).Tissue Doppler imaging(TDI)was used to obtain the tricuspid anular velocity curve and to measure the peak velocity(E')in the early diastolic period and the peak velocity(A')in the late diastolic period,and E'/A'ratio was subsequently calculated.Isovolumic contraction time(ICT),isovolumic relaxation time(IRT),filling time(FT),ejection time(ET),and cardiac cycle(CT)were also measured.The myocardial performance index(RVMPI),systolic-to-diastolic time index(SDI),systolic to diastolic duration ratio(SDR),filling time fraction(FTF),and ejection time fraction(ETF)of the fetal right heart were calculated by the formulas.The parameters between the two groups were compared.Results The mean values of IRT[(43.21±4.88)ms vs(45.71±5.12)ms,P<0.05],ICT[(42.79±5.59)ms vs(47.82±7.09)ms,P<0.05],(ICT+IRT)[(87.29±7.78)ms vs(93.51±10.48)ms,P<0.05],and FT value[(124.46±4.70)ms vs(142.00±15.77)ms,P<0.05]were significantly shorter in the RVOTO group than in the normal group.The RVMPI(0.52±0.06 vs 0.48±0.07,P<0.001),SDI(2.17±0.18 vs 1.95±0.24,P<0.001),SDR(1.35±0.12 vs 1.22±0.12,P<0.001),and FTF(0.31±0.02 vs 0.34±0.03,P<0.001)were significantly higher in the RVOTO group than in the normal group.The values of E'(6.38±1.82 vs 5.59±1.96,P<0.001)and E'/A'ratio(0.62±0.11 vs 0.51±0.12,P<0.001)of the tricuspid annulus were significantly higher in the normal group than in the RVOTO group.Conclusion The fetal echocardiographic parameters right ventricular MPI,SDI,SDR,FTF,E

关 键 词：超声心动图 右心室流出道梗阻性疾病 心肌做功指数 时间间期 右心功能 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]