应用二维斑点追踪成像技术评估孕周及心尖方向对中晚孕期正常胎儿左心房应变的影响  

Impact of gestational age and apex orientation on left atrial strain assessed by two-dimensional speckle tracking imaging in normal fetuses during the second and third trimesters

作　　者：杜祖升 赵博文[1] 张帧 潘美[1] 彭晓慧[1] 陈冉[1] 毛彦恺[1] Du Zusheng;Zhao Bowen;Zhen Zhang;Pan Mei;Peng Xiaohui;Chen Ran;Mao Yankai(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,No.2 Hospital of Yinzhou,Ningbo 315040,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]浙江省宁波市鄞州区第二医院超声科,宁波315040

出　　处：《中华医学超声杂志（电子版）》2024年第9期843-851,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：浙江省基础公益研究计划项目(LGF20H180013);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成像技术(2D-STI)在评估胎儿左心房应变3个时相功能中的应用价值、左心房应变3个时相功能与孕周的相关性以及该技术在胎儿心脏检查实际应用中对心尖方向是否存在角度依赖性。方法选取2021年11月至2022年1月在浙江大学医学院附属邵逸夫医院超声科接受胎儿超声心动图检查的正常妊娠中、晚孕期单胎胎儿180例,共获取611个不同心尖角度胎儿四腔心动态图像,应用2D-STI分析获得左心房储存期峰值应变(LASr_ED)、管道期峰值应变(LAScd_ED)和收缩期峰值应变(LASct_ED),其中有11例共计32个动态图像2D-STI分析心房收缩的起始点不能识别,无法区分心房收缩期与管道期。选取169例四腔心切面心尖方向为10:30~1:30能良好追踪并识别左心房3个时相功能的病例与孕周进行线性回归分析。选取能良好追踪并识别左心房3个时相的动态图像579个,其中中孕期18~24周的图像126个、25~28周的图像190个,晚孕期29~32周的图像150个、33~36孕周的图像113个;按不同心尖方向分成4组,组1心尖方向10:30~1:30,组2心尖方向1:30~4:30,组3心尖方向4:30~7:30,组4心尖方向7:30~10:30;同一孕期不同心尖方向组间应变参数比较采用F检验和LSD-t检验。结果2D-STI能够成功追踪并识别胎儿左心房3个时相应变的比例为94.76%(579/611)。线性回归分析显示,LASr_ED随孕周增加而减小(r=-0.32,P<0.001),LAScd_ED随孕周增加而增大(r=0.15,P<0.05),LASct_ED随孕周增加而减小(r=-0.35,P<0.001)。中孕期18~24周、25~28周不同心尖方向4组左心房3个应变参数比较,差异均无统计学意义(P均>0.05);晚孕期29~32周不同心尖方向4组胎儿的LASr_ED总体均数比较,差异存在统计学意义(F=2.759,P=0.044);晚孕期33~36周不同心尖方向4组胎儿的LASr_ED及LAScd_ED总体均数比较,差异存在统计学意义(F=2.919,P=0.037;F=4.234,P=0.007)。4组间两两比较,同一孕期组1和组3的LASr_ED、LAScObjective To assess the application value of two-dimensional speckle tracking imaging(2D-STI)in the evaluation of fetal left atrial strain in three phases,and to explore the correlation between the three phases of left atrial strain and gestational age,and whether the technique has angular dependence on the apex orientation in fetal heart examination.Methods A total of 180 normal singleton fetuses in the second and third trimesters who underwent fetal echocardiography at the Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College of Medicine from November 2021 to January 2022 were selected.A total of 611 fetal four-chamber view video clips with different apex angles were obtained.2D-STI analysis was used to obtain the peak storage strain(LASr_ED),peak pipeline strain(LAScd_ED),and peak systolic strain(LASct_ED)of the left atrium.2D-STI could not identify the onset of atrial contraction in 11 fetuses(32 dynamic images),and could not distinguish the atrial contraction phase from the conduit phase.Linear regression analysis was used to analyze the relationship between gestational age and 2D-STI parameters in patients in whom the three phases of left atrial strain with the apex orientation of 10:30 to 1:30 in the four-chamber view could be well tracked and identified.A total of 579 dynamic images with good tracking and recognition of the three phases of left atrial strain were selected,including 126 during 18-24 gestational weeks,190 during 25-28,150 during 29-32,and 113 during 33-36.The patients were divided into four groups according to the apex orientation:group 1(apex orientation:10:30-1:30),group 2(1:30-4:30),group 3(4:30-7:30),and group 4(7:30-10:30).The F test and LSD-t test were used to compare the left atrial strain parameters between different groups of normal fetuses in the same gestational weeks.Results 2D-STI could successfully track and identify the three temporal variations of the left atrium in 94.76%(579/611)of fetuses.LASr_ED and LASct_ED decreased

关 键 词：超声心动描记术 胎儿 心房功能 二维斑点追踪技术 

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