切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (09) : 951 -958. doi: 10.3877/cma.j.issn.1672-6448.2023.09.010

妇产科超声影像学

应用多普勒超声定量分析正常中晚孕期胎儿左心室收缩舒张时间指数
赵红娟, 赵博文†(), 潘美, 纪园园, 彭晓慧, 陈冉   
  1. 310016　杭州，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;311300　杭州，浙江省杭州市临安区第一人民医院超声科
    310016　杭州，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
  • 收稿日期:2022-09-06 出版日期:2023-09-01
  • 通信作者: 赵博文
  • 基金资助:
    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)

Measurement of left ventricular systolic to diastolic time index in normal fetuses in the second and third trimesters using both spectral and tissue Doppler echocardiography

Hongjuan Zhao, Bowen Zhao†(), Mei Pan, Yuanyuan Ji, Xiaohui Peng, Ran Chen   

  1. 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, Lin'an District First People’s Hospital, Hangzhou 311300, China
    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
  • Received:2022-09-06 Published:2023-09-01
  • Corresponding author: Bowen Zhao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

赵红娟, 赵博文, 潘美, 纪园园, 彭晓慧, 陈冉. 应用多普勒超声定量分析正常中晚孕期胎儿左心室收缩舒张时间指数[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 951-958.

Hongjuan Zhao, Bowen Zhao, Mei Pan, Yuanyuan Ji, Xiaohui Peng, Ran Chen. Measurement of left ventricular systolic to diastolic time index in normal fetuses in the second and third trimesters using both spectral and tissue Doppler echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 951-958.

目的

建立中晚孕期胎儿左心室收缩舒张时间指数（SDI）的正常值参考范围，并探讨胎儿孕周、胎心率对SDI的影响以及应用SDI评估胎儿心功能的可行性。

方法

采用脉冲多普勒（PD）和组织多普勒（TDI）对2021年9月至2022年2月在浙江大学医学院附属邵逸夫医院超声科进行胎儿超声心动图检查的408例正常中晚孕期（18~38周）单胎儿左心室功能指标进行测量。应用PD法/TDI法分别获得胎儿左心的等容收缩时间（ICT/ICT'）、等容舒张时间（IRT/IRT'）、充盈时间（FT/FT'）和射血时间（ET/ET'）4个胎儿心脏时间间期，并通过公式计算胎儿左心的SDI/SDI'及心肌做功指数（MPI/MPI'）。获得SDI和SDI'正常值参考范围，采用配对t检验分析PD法和TDI法分别测得的SDI与SDI'的差异，对SDI、SDI'与孕周、胎心率之间进行直线相关（Pearson）分析，采用多因素线性回归分析舒张功能指标E/A、E'/A'、E/E'以及整体心功能指标MPI和MPI'对SDI及SDI'的影响。采用组内相关系数（ICC）评估4个时间间期的测量者内和测量者间重复性。

结果

PD法测得SDI正常值为1.380±0.141；TDI法测得SDI'正常值为1.499±0.167，2种方法测得的SDI、SDI'值间差异具有统计学意义（t=-13.55，P<0.001）。直线相关分析显示SDI与孕周呈负相关（r=-0.267，P<0.001），SDI'与孕周呈负相关（r=-0.179，P<0.001），均随孕周增加略有下降；SDI与胎心率呈正相关（r=0.324，P<0.001），SDI'与胎心率呈正相关（r=0.290，P<0.001）。多因素线性回归分析结果显示，E/A、E/E'、MPI的变化对SDI的影响存在统计学意义；E'/A'、MPI'的变化对SDI'的影响存在统计学意义。重复性检验结果显示2种多普勒超声测得的4个时间间期的测量者内和测量者间组内相关系数值均>0.75，表示信度良好、可重复性高。

结论

通过PD与TDI定量测量并建立了中晚孕期正常胎儿左心室SDI、SDI'的正常值参考范围，TDI测值高于PD测值，测量简便易行，均可为临床监测正常胎儿时间间期指数提供参考依据。

关键词: 胎儿, 超声心动图, 收缩舒张时间指数, 时间间期, 心功能
Objective

To establish the normal reference range of left ventricular systolic to diastolic time index (SDI) in normal fetuses in the second and third trimesters by using both spectral and tissue Doppler echocardiography, to assess the effect of fetal gestational age (GA) and fetal heart rate (FHR) on SDI, and to explore the feasibility of using SDI to evaluate fetal left ventricular function.

Methods

The left ventricular time intervals were obtained in 408 singleton fetuses between 18 to 38 weeks of gestation by using pulse wave Doppler (PD) and tissue Doppler imaging (TDI) at the Department of Ultrasonography of Run Run Shaw Hospital, Zhejiang University School of Medicine. SDI and SDI' were then calculated. Isovolumetric contraction time (ICT/ICT'), isovolumetric relaxation time (IRT/IRT'), filling time (FT/FT'), and ejection time (ET/ET') of the fetal left ventricle were obtained by PD and TDI, respectively. Left ventricular SDI, SDI', and myocardial performance index (MPI/MPI') were calculated subsequently. Normal reference range values of SDI and SDI' were obtained, and paired t-test was used to analyze the differences between the SDI and SDI' values measured by PD and TDI, respectively. The correlation between SDI/SDI' and the independent variables GA and FHR was analyzed by linear correlation (Pearson) analysis, and multivariate linear regression was used to analyze the effects of SDI and SDI' on diastolic function indexes (E/A, E'/A', and E/E') and the indicator of overall cardiac function (MPI/MPI'). Intra- and inter-measurement reproducibility was assessed using the intra-group correlation coefficient (ICC).

Results

The normal reference range of SDI was 1.380±0.141 and that of SDI' was 1.499±0.167; paired t-test analysis showed a statistical difference between the SDI and SDI' values measured by PD and TDI, respectively (t=-13.55, P<0.001). Line correlation analysis showed a negative correlation between SDI and GA (r=-0.267, P<0.001), and SDI' decreased with the increase of GA (r=-0.179, P<0.001). SDI was positively correlated with FHR (r=0.324, P<0.001), and SDI' was also positively correlated with FHR (r=0.290, P<0.001). Multivariate linear regression analysis demonstrated that the values of E/A, E/E', and MPI had influence on SDI, and the values of E'/A' and MPI' had influence on SDI'. The results of the repeatability test showed that the values of the correlation coefficient were all greater than 0.75, indicating good reliability and high repeatability.

Conclusion

The normal reference range of left ventricular SDI and SDI' has been established in normal fetuses in the second and third trimesters by using PD and TDI quantification, which provides a reference basis for clinical monitoring of normal fetal ventricular time interval index. Fetal left ventricular SDI/SDI' may have new potential for the clinical evaluation of fetal heart function.

Key words: Fetal, Echocardiography, Systolic to diastolic time index, Time interval, Cardiac function
图1 脉冲多普勒（PD）测量胎儿收缩期及舒张期时间间期。图a：正常胎儿心尖五腔心切面彩色多普勒成像引导PD取样容积放置在左心室流入道与流出道交界处；图b：左心室流入道与流出道多普勒频谱及时间间期的测量 注：A波为心房收缩期（左心室舒张晚期）；E波为左心室舒张早期；ET为射血时间；FT为充盈时间；ICT为等容收缩时间；IRT为等容舒张时间；LA为左心房；LV为左心室；RA为右心房；RV为右心室；S波为左心室射血期
图2 组织多普勒（TDI）测量胎儿收缩期及舒张期时间间期。图a：正常胎儿心尖四腔心切面TDI引导脉冲多普勒取样容积放置在二尖瓣环室间隔侧；图b：二尖瓣环室间隔侧TDI频谱及时间间期测量 注：A'波为心房收缩期（左室舒张晚期）；E'波为左心室舒张早期；ET'为射血时间；FT'为充盈时间；ICT'为等容收缩时间；IRT'为等容舒张时间；LA为左心房；LV为左心室；RA为右心房；RV为右心室；S'波为左室收缩期
图3 胎儿心动周期频谱示意图 注：cycle time为胎儿心动周期；A波为心房收缩期（左心室舒张晚期）；E波为左心室舒张早期；S波为左心室射血期；ET为射血时间；FT为充盈时间；ICT为等容收缩时间；IRT为等容舒张时间
表1 不同孕周正常胎儿左心室2种多普勒方法测得SDI和SDI'参考值比较（）
参数 18~22周 23~27周 28~32周 33~38周 18~38周
SDI 1.407±0.136 1.406±0.135 1.359±0.138 1.305±0.101 1.380±0.141
SDI' 1.558±0.137 1.503±0.162 1.501±0.168 1.398±0.186 1.499±0.167
t值 -4.153 -5.987 -8.645 -2.304 -13.554
P值 <0.001 <0.001 <0.001 0.025 <0.001
图4 脉冲多普勒测得收缩舒张时间指数（SDI）与孕周的相关性散点图
图5 组织多普勒测得收缩舒张时间指数（SDI'）与孕周的相关性散点图
图6 脉冲多普勒测得收缩舒张时间指数（SDI）与胎心率的相关性散点图
图7 组织多普勒测得收缩舒张时间指数（SDI'）与胎心率的相关性散点图
表2 胎儿心功能参数对SDI影响的多重线性回归分析
变量 b值 b值标准误 t值 P值
E/A -0.460 0.067 -6.890 <0.001
E/E' 0.016 0.004 4.344 <0.001
MPI 0.602 0.113 5.310 <0.001
表3 胎儿心功能参数对SDI'影响的多重线性回归分析
变量 b值 b值标准误 t值 P值
E'/A' -0.338 0.083 -4.079 <0.001
E/E' -0.004 -0.839 -0.839 0.402
MPI' 0.882 0.123 7.157 <0.001
表4 正常中晚孕期胎儿左心室2种多普勒方法测值的重复性检验
变量 测量者间ICC 测量者内ICC
FT/FT' 0.883/0.917 0.901/0.913
ET/ET' 0.872/0.901 0.899/0.921
ICT/ICT' 0.885/0.895 0.891/0.899
IRT/IRT' 0.870/0.891 0.925/0.917
1
阿尔弗莱德·阿布汗默德, 拉宾·查欧里. 胎儿超声心动图实用指南: 正常和异常心脏 [M]. 刘琳, 主译. 3版. 北京: 北京科学技术出版社, 2017: 175-176.
2
Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathy [J]. J Cardiol, 1995, 26(6): 357-366.
3
Tsutsumi T, Ishii M, Eto G, et al. Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index [J]. Pediatr Int, 1999, 41(6): 722-727.
4
Hernandez-Andrade E, Lopez-Tenorio J, Figueroa-Diesel H, et al. A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment [J]. Ultrasound Obstet Gynecol, 2005, 26(3): 227-232.
5
Hernandez-Andrade E, Figueroa-Diesel H, Kott man C, et al. Gestational-age-adjusted reference values for the modified myocardial performance index for evaluation of fetal left cardiac function [J]. Ultrasound Obstet Gynecol, 2007, 29(3): 321-325.
6
Van Mieghem T, Gucciardo L, Lewi P, et al. Validation of the fetal myocardial performance index in the second and third trimesters of gestation [J]. Ultrasound Obstet Gynecol, 2009, 33(1): 58-63.
7
赵博文, 潘美, 汤富刚, 等. Tei指数综合评估正常胎儿心室功能的定量研究 [J]. 中华超声影像学杂志, 2004, 13(3): 165-169.
8
Sun L, Wang J, Su X, et al. Reference ranges of fetal heart function using a modified myocardial performance index: a prospective multicentre, cross-sectional study [J]. BMJ Open, 2021, 11(7): e049640.
9
Peixoto AB, Bravo-Valenzuela NJM, Martins WP, et al. Reference ranges of filling time and systolic-to-diastolic time index of the left ventricle, right ventricle, and interventricular septum using both spectral and tissue Doppler of fetal heart between 20 and 36 + 6 weeks of gestation [J]. Eur J Obstet Gynecol Reprod Biol, 2020, 252(9): 366-372.
10
Nawaytou HM, Peyvandi S, Brook MM, et al. Right ventricular systolic-to-diastolic time index: hypoplastic left heart fetuses differ significantly from normal fetuses [J]. J Am Soc Echocardiogr, 2016, 29(2): 143-149.
11
谭宜, 周启昌, 王小艳, 等. Tei指数在胎儿心功能评价中的应用 [J]. 中国医学影像技术, 2005, 21(4): 592-594.
12
张娜, 吴青青, 孙丽娟, 等. 心肌做功指数在评价帆状胎盘孕妇胎儿心功能中的应用[J/CD]. 中华医学超声杂志(电子版), 2019, 16(7): 535-541.
13
Bhorat IE, Bagratee JS, Pillay M, et al. Determination of the myocardial performance index in deteriorating grades of intrauterine growth restriction and its link to adverse outcomes [J]. Prenat Diagn, 2015, 35(3): 266-273.
14
Bhorat IE, Bagratee JS, Pillay M, et al. Use of the myocardial performance index as a prognostic indicator of adverse fetal outcome in poorly controlled gestational diabetic pregnancies [J]. Prenat Diagn, 2014, 34(13): 1301-1306.
15
Peixoto AB, Bravo-Valenzuela NJM, Mattar R, et al. Reference values for left and right ventricular systolic-to-diastolic duration ratio (SDR) found using both spectral and tissue Doppler of fetal heart between 20 and 36+6 weeks of gestation [J]. Int J Cardiovasc Imaging, 2021, 37(9): 2717-2726.
16
潘美, 赵博文, 毛彦恺, 等. 三种多普勒超声检查方法在定量测定胎儿心脏房室传导时间的应用 [J/OL]. 中华医学超声杂志(电子版), 2021, 18(7): 681-687.
[1] 何金梅, 尹立雪, 谭静, 张文军, 王锐, 任梅, 廖明娇. 超声心肌做功技术对2型糖尿病患者潜在左心室心肌收缩功能损伤的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1029-1035.
[2] 薛艳玲, 马小静, 谢姝瑞, 何俊, 夏娟, 何亚峰. 左心声学造影在急性心肌梗死合并室间隔穿孔中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1036-1039.
[3] 武玺宁, 欧阳云淑, 张一休, 孟华, 徐钟慧, 张培培, 吕珂. 胎儿心脏超声检查在抗SSA/Ro-SSB/La抗体阳性妊娠管理中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1056-1060.
[4] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1061-1067.
[5] 张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1074-1080.
[6] 刘丹妮, 敖梦, 冉海涛, 李世玉, 秦芳. 三维超声心动图及二维斑点追踪成像对持续性心房颤动复律后双心房逆向重构的评估[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 827-835.
[7] 张璟璟, 赵博文, 潘美, 彭晓慧, 毛彦恺, 潘陈可, 朱玲艳, 朱琳琳, 蓝秋晔. 胎儿超声心动图测量McGoon指数在评价胎儿肺血管发育中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 860-865.
[8] 旺久, 陈军, 朱霞, 米玛央金, 赵胜, 陈欣林, 李建华, 王双. 山南市妇幼保健院开展胎儿系统超声筛查的效果分析[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 728-733.
[9] 徐鹏, 李军, 高巍伦, 王峥, 庞珅, 李春妮, 朱霆. 快速旋转扫查法在胎儿超声心动图检查中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 761-766.
[10] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 581-587.
[11] 吴赤球, 韦曙东, 张辉, 严许清, 梅朵卓嘎, 余丹. 驻不同海拔高度高原人员习服后心脏结构和功能变化的超声心动图评估[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 588-593.
[12] 谭芳, 杨娇娇, 沈玉琴, 李炎菲海, 王海蕊, 范思涵, 纪学芹. 胎儿心脏定量分析技术对正常胎儿心脏形态及收缩功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 598-604.
[13] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[14] 黄佳, 石华, 张玉国, 胡佳琪, 陈茜. 胎儿左头臂静脉正常与异常超声图像特征及其临床意义[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 610-617.
[15] 薛念余, 张盛敏, 吴凌恒, 沙蕾, 童揽月, 沈崔琴, 李朝军, 杜联芳. 研究血清胆红素对2型糖尿病患者心脏结构发生改变前心肌功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1004-1009.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号