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中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (08) : 771 -776. doi: 10.3877/cma.j.issn.1672-6448.2021.08.011

所属专题: 妇产科超声

妇产科超声影像学

Ebstein畸形胎儿三尖瓣隔瓣下移与瓣环位移Z评分评估心室收缩功能受损程度的相关性研究
郭显峰1,(), 赵博文2, 李益林3   
  1. 1. 325400 温州,浙江平阳县人民医院超声科
    2. 310016 杭州,浙江大学医学院附属邵逸夫医院超声科
    3. 325400 温州,浙江平阳县人民医院麻醉科
  • 收稿日期:2020-10-07 出版日期:2021-08-01
  • 通信作者: 郭显峰
  • 基金资助:
    温州市科技计划项目(Y20180743)

Correlation of displacement degree of the tricuspid valve and impaired ventricular systolic function evaluated by annular plane systolic excursion Z-score in Ebstein anomaly fetuses

Xianfeng Guo1,(), Bowen Zhao2, Yilin Li3   

  1. 1. Department of Ultrasonography, People's Hospital of Pingyang County, Wenzhou 325400, China
    2. Department of Anesthesia, People's Hospital of Pingyang County, Wenzhou 325400, China
    3. Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, China
  • Received:2020-10-07 Published:2021-08-01
  • Corresponding author: Xianfeng Guo
引用本文:

郭显峰, 赵博文, 李益林. Ebstein畸形胎儿三尖瓣隔瓣下移与瓣环位移Z评分评估心室收缩功能受损程度的相关性研究[J/OL]. 中华医学超声杂志(电子版), 2021, 18(08): 771-776.

Xianfeng Guo, Bowen Zhao, Yilin Li. Correlation of displacement degree of the tricuspid valve and impaired ventricular systolic function evaluated by annular plane systolic excursion Z-score in Ebstein anomaly fetuses[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(08): 771-776.

目的

通过二、三尖瓣瓣环位移Z评分评估Ebstein畸形(EA)胎儿左、右心室功能受损程度,分析三尖瓣隔瓣下移程度分别与左右心室收缩功能受损程度的相关性,探讨心室收缩功能受损机制。

方法

2014年9月至2019年12月应用解剖M型超声测量浙江平阳县人民医院及浙江大学医学院附属邵逸夫医院1012名正常胎儿及25例EA胎儿三尖瓣环位移(FAM-TAPSE)及二尖瓣环位移(FAM-MAPSE)值,计算并比较正常组与EA组胎儿Z评分差异,测量EA组胎儿二尖瓣前瓣与三尖瓣隔瓣附着点之间距离(MTD),分析MTD与心脏长轴长度(CL)的比值(MTD/CL)与瓣环位移Z评分的相关性以及FAM-MAPSE Z评分与FAM-TAPSE Z评分的相关性。

结果

EA组胎儿FAM-MAPSE Z评分和FAM-TAPSE Z评分与正常组胎儿差异均有统计学意义(-1.940±1.791 vs -0.135±0.967,-4.358±0.618 vs -0.031±0.919,均P<0.01)。EA组FAM-TAPSE Z评分均<-2,36%的FAM-MAPSE Z评分<-2。FAM-TAPSE Z评分与MTD/CL呈高度负相关(r =-0.800,P<0.001)。FAM-MAPSE Z评分与MTD/CL不存在显著的相关关系(r =-0.135,P=0.519),FAM-MAPSE Z评分与FAM-TAPSE Z评分呈中度正相关(r =0.350,P<0.05)。

结论

EA胎儿右心室收缩功能减低与三尖瓣隔瓣下移程度明显相关,部分胎儿伴随左心室收缩功能减低,但与三尖瓣隔瓣下移无明显相关性,三尖瓣隔瓣下移并不是导致左心室收缩功能减低的原因。

Objective

To investigate the correlation of the displacement degree of the tricuspid valve and impaired ventricular systolic function evaluated by tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) Z-score in Ebstein anomaly (EA) fetuses, and explore the mechanism of impaired ventricular systolic function.

Methods

A total of 1024 normal fetuses and 25 fetuses with EA diagnosed at the People's Hospital of Pingyang County and Sir Run Run Shaw Hospital from September 2014 to December 2019 were included. TAPSE and MAPSE were measured by free angle M-mode (FAM) echocardiography, and the Z-scores of TAPSE and MAPSE were calculated and compared between normal and EA fetuses. Mitral valve-tricuspid valve distance (MTD) and cardiac length (CL) were measured, and then the correlation of MTD/CL with FAM-TAPSE and FAM-MAPSE Z-scores, as well as the correlation of FAM-TAPSE with FAM-MAPSE Z-score was analyzed.

Results

Compared with normal fetuses, the mean Z-scores of FAM-TAPSE and FAM-MAPSE were both statistically different in fetuses with EA (-1.940±1.791 vs -0.135±0.967, -4.358±0.618 vs -0.031±0.919, P<0.001 for both). All FAM-TAPSE Z-scores of EA cases were<-2 and only 36% (9/25) of FAM-MAPSE Z-scores of EA cases were<-2. FAM-TAPSE Z-score was highly negatively correlated with MTD/CL (r = -0.800, P<0.001), but there was no significant correlation between FAM-MAPSE Z-score and MTD/CL (r = -0.135, P=0.519). FAM-TAPSE Z-score correlated positively with FAM-MAPSE (r = 0.350, P<0.05).

Conclusion

There are varying degrees of decline in right ventricular systolic function in fetuses with EA, and the displacement degree of the tricuspid valve exhibits a significantly negative correlation with FAM-TAPSE Z-score, which may be related to the right ventricular myocardial fibrosis caused by the regurgitation of the tricuspid valve. The left ventricular systolic function of some fetuses with EA decline, but it has no connection with the displacement degree of the tricuspid valve.

图1 Ebstein畸形(EA)胎儿各指标超声测量方法。图a为应用解剖M型超声心动图测量EA胎儿二尖瓣环位移(FAM-MAPSE)(箭头所示);图b为应用解剖M型超声心动图测量EA胎儿三尖瓣环位移(FAM-TAPSE)(箭头所示);图c为测量EA胎儿二尖瓣前瓣与三尖瓣隔瓣附着点之间距离(MTD)(箭头所示)
表1 正常胎儿心脏FAM-TAPSE及FAM-MAPSE 的Z评分数据模型5, 6
表2 EA胎儿与正常胎儿心脏瓣环位移Z评分比较(
xˉ
±s)
图2 正常组及Ebstein畸形(EA)组胎儿解剖M型超声心动图测量胎儿三尖瓣环位移(FAM-TAPSE)Z评分的散点图。图中实线表示正常胎儿FAM-TAPSE Z评分的均数,2条虚线之间为正常胎儿FAM-TAPSE Z评分-2~+2之间区域
图3 正常组及Ebstein畸形(EA)组胎儿解剖M型超声心动图测量胎儿二尖瓣环位移(FAM-MAPSE)Z评分散点图。图中实线表示正常胎儿FAM-MAPSE Z评分的均数,2条虚线之间为正常胎儿FAM-MAPSE Z评分-2~+2之间区域
表3 EA胎儿与正常胎儿心脏瓣环位移Z评分分布区域比较[例(%)]
图4 解剖M型超声心动图测量胎儿三尖瓣环位移(FAM-TAPSE)和胎儿二尖瓣环位移(FAM-MAPSE)与室间隔处二尖瓣前瓣与三尖瓣隔瓣附着点距离/心脏长轴长度(MTD/CL)的相关性分析散点图。图a为FAM-TAPSE Z评分与MTD/CL相关性分析散点图;图b为FAM-MAPSE Z评分与MTD/CL相关性分析散点图
图5 胎儿三尖瓣环位移(FAM-TAPSE)与胎儿二尖瓣环位移(FAM-MAPSE)Z评分相关性分析散点图
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