二维斑点追踪超声心动图定量评估左心室流出道梗阻胎儿左心房功能  

Quantitative evaluation of left atrial function in fetuses with left ventricular outflow tract obstruction using two-dimensional speckle tracking echocardiography

作　　者：周丽梅 赵博文[1] 潘美[1] 彭晓慧[1] 陈冉[1] 田园诗 张铭旋 狄敏 Zhou Limei;Zhao Bowen;Pan Mei;Peng Xiaohui;Chen Ran;Tian Yuanshi;Zhang Mingxuan;Di Min(Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College 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 Ultrasound,Ningbo Medical Center Li Huili Hospital of Zhejiang,Ningbo 315046,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]浙江省宁波市医疗中心李惠利医院超声科,宁波315046

出　　处：《中华超声影像学杂志》2024年第9期767-775,共9页Chinese Journal of Ultrasonography

基　　金：国家重点研发计划项目(2023YFC2705700);浙江大学科学技术研究院一般横向项目(校合-2021-KYY-518053-0055)。

摘　　要：目的:探讨二维斑点追踪技术(2D-STE)在定量评估正常胎儿及左心室流出道梗阻(LVOTO)胎儿左心房功能中的应用价值。方法:回顾性选取2020年5月至2022年6月在浙江大学医学院附属邵逸夫医院接受胎儿超声心动图检查并被诊断为LVOTO的胎儿32例作为病例组,另选取2019年1月至2022年10月接受胎儿超声心动图检查结果正常的单胎胎儿100例作为对照组。获取标准的基底或心尖四腔心切面动态图像,通过TomTec-Arena离线心脏分析软件进行定量分析。获取两组胎儿左心房应变参数:左心房储存期纵向应变(LASr)、左心房导管期纵向应变(LAScd)、左心房收缩期纵向应变(LASct);同时测量两组胎儿常规产科超声及胎儿心脏超声参数:双顶径(BPD)、股骨长(FL)、收缩末期主动脉瓣环内径(AO)、收缩末期肺动脉瓣环内径(PA)、左心房收缩末期长径(LAESL)、左心房收缩末期横径(LAESD)、右心房收缩末期长径(RAESL)、右心房收缩末期横径(RAESD)、左心室舒张末期横径(LVEDD)、右心室舒张末期横径(RVEDD),计算右心室舒张末期横径与左心室舒张末期横径比值(RVd/LVd),肺动脉瓣环内径与主动脉瓣环内径比值(PA/AO)。比较两组胎儿各应变参数的差异并对两组胎儿各应变参数与孕周、RVd/LVd以及其他常规测量参数的相关性进行分析。利用ROC曲线比较LASr及RVd/LVd评估LVOTO胎儿心脏功能异常的特异性和敏感性。结果:两组间LASr、LAScd、LASct、MAPSE、AO、LAESL、LVEDD、RVd/LVd及PA/AO差异有统计学意义(均P<0.05),余参数比较差异无统计学意义(均P>0.05)。相关性分析显示,LVOTO组LASr与RVd/LVd呈负相关(r_(s)=-0.394,P=0.025),LASct与RVd/LVd呈负相关(r_(s)=-0.626,P=0.004);对照组LASr与孕周、AO、PA呈负相关(r/r_(s)=-0.570、-0.440、-0.493,均P<0.001),LASct与孕周、AO、PA呈负相关(r/r_(s)=-0.601、-0.532、-0.568,均P<0.001),LAScd与孕周、AO、PA呈正相关(r/r_(s)=0.310、0.370、0.3ObjectiveTo explore the potential application of two-dimensional speckle tracking echocardiography (2D-STE) in terms of quantification and evaluating left atrial function in normal fetuses and fetuses with left ventricular outflow tract obstruction (LVOTO).MethodsA total of 32 fetuses diagnosed with LVOTO, who underwent fetal echocardiography at Sir Run Run Shaw Hospital, Zhejiang University College of Medicine between May 2020 to June 2022, were selected as the case group, and 100 pregnant women with normal singleton fetuses between January 2019 to October 2022 were chosen as the control group. The standard basal or apical four-chamber view clips were obtained and were quantitatively analyzed using TomTec-Arena off-line cardiac analysis software to obtain the left atrial strain parameters of the two groups of fetuses including left atrial reservoir phase longitudinal strain(LASr), left atrial ductal phase longitudinal strain(LAScd), left atrial systolic phase longitudinal strain (LASct), as well as the routine obstetric ultrasound measurements and fetal echocardiographic parameters of the two groups: biparietal diameter (BPD), femur length (FL), aortic annulus end-systolic inner diameter (AO), pulmonary annulus end-systolic inner diameter (PA), left atrial end-systolic long length (LAESL), left atrial end-systolic transverse diameter (LAESD), right atrial end-systolic long length (RAESL), right atrial end-systolic transverse diameter (RAESD), left ventricular end-diastolic transverse diameter (LVEDD) and right ventricular diastole end-diastolic transverse diameter (RVEDD). The ratio of right ventricular end-diastolic transverse diameter to left ventricular end-diastolic transverse diameter (RVd/LVd) and the ratio of pulmonary annulus diameter to aortic annulus diameter (PA/AO) were calculated. The differences of strain parameters between the two groups were compared, and the correlation between strain parameters and gestational age, RVd/LVd and other conventional measurement parameters were analyzed. ROC curve w

关 键 词：二维斑点追踪超声心动图 左心室流出道梗阻 胎儿 心房功能 左 应变 

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