初步探讨胎儿心脏参数对胎儿生长受限（FGR）的预测价值。

选取2018年1月至2022年4月妊娠晚期在温州医科大学附属第二医院进行胎儿超声心动图检查的临床可疑FGR的孕妇50例（观察组），选取同时间段胎儿心脏检查孕周、年龄匹配的正常孕妇56例（对照组）。可疑FGR孕妇根据出生后新生儿体质量分为2个亚组：FGR确认组和FGR改善组。收集胎儿的生长情况及脐动脉血流、大脑中动脉血流、主动脉峡部血流情况；获得胎儿的心脏参数，包括右心房横径、左心房横径、左心室横径、右心室横径、肺动脉内径、主动脉内径、主动脉峡部内径、动脉导管弓内径、右心房横径/左心房横径、右心室横径/左心室横径、左心室球形指数、右心室球形指数、左心室球形指数/右心室球形指数、主动脉内径/肺动脉内径、主动脉峡部内径/动脉导管弓内径；并获取孕妇基本临床资料、分娩情况和妊娠结局。采用方差分析或Kruskal-Wallis秩检验比较FGR确认组、FGR改善组和对照组三组间上述参数的差异，进一步组间两两比较采用LSD-t检验或Bonferroni法校正；各参数与FGR确认组、FGR改善组分组的相关性分析采用Spearman相关分析，采用受试者工作特征（ROC）曲线评估各参数诊断FGR的效能。

FGR确认组与FGR改善组相比，右心房横径/左心房横径值较高[1.27（1.10，1.44）vs 1.09（1.00，1.20）]，差异具有统计学意义（Z=2.581，P=0.030），主动脉峡部内径、主动脉峡部内径/动脉导管弓内径、左心室球形指数/右心室球形指数值较低[2.80（2.50，3.25）mm vs 3.50（3.03，3.78）mm；0.73±0.18 vs 0.96±0.19；0.72±0.11 vs 0.80±0.11]，差异具有统计学意义（Z=-3.673，P=0.001；t=-5.043，P<0.001；t=-2.255，P=0.026）。FGR确认组与对照组相比，主动脉峡部内径[2.80（2.50，3.25）mm vs 3.30（3.00，3.80）mm]、主动脉峡部内径/动脉导管弓内径（0.73±0.18 vs 1.00±0.12）、左心室球形指数/右心室球形指数（0.72±0.11 vs 0.83±0.14）、左心房横径[11.0（10.0，12.0）mm vs 12.0（11.0，13.0）mm]较低，右心房横径/左心房横径[1.27（1.10，1.44）vs 1.00（1.00，1.10）]、右心房横径[14.0（12.5，16.0）mm vs 12.0（11.0，14.0）mm]、右心室横径/左心室横径[1.12（1.04，1.32）vs 1.00（0.93，1.10）]、右心室球形指数[0.62（0.58，0.71）vs 0.58（0.52，0.65）]、动脉导管弓内径[3.90（3.45，4.70）mm vs 3.35（3.08，3.75）mm]较高，差异均具有统计学意义（Z=-3.991，P<0.001；t=-7.143，P<0.001；t=-3.904，P<0.001；Z=-2.624，P=0.026；Z=4.959，P<0.001；Z=2.599，P=0.028；Z=3.591；P=0.001；Z=2.530，P=0.034；Z=3.722，P=0.001）。FGR改善组与对照组相比，各参数差异均无统计学意义（P均>0.05）。FGR确认组、FGR改善组分组的相关性分析显示，体质量指数、主动脉峡部舒张期可见逆向血流、脐动脉血流和（或）大脑中动脉血流是否异常、是否早产、是否急诊剖宫产、是否胎盘或脐带异常与FGR确认组、FGR改善组分组相关（r=0.306，P=0.036；r=0.587，P<0.001；r=0.450，P=0.001；r=0.542，P<0.001；r=0.421，P=0.002；r=0.365，P=0.010），是否合并妊娠糖尿病、是否合并妊娠高血压、是否合并羊水少、是否在32周前怀疑FGR与FGR确认组、FGR改善组分组无统计学相关性（P均>0.05）。在观察组中，主动脉峡部内径/动脉导管弓内径、主动脉峡部内径诊断FGR的敏感度分别为75%、83%，特异度分别为72%、68%，ROC曲线下面积分别为0.81、0.77。

胎儿心脏右心增大、主动脉峡部内径缩小与FGR密切相关，可用于协助诊断FGR，主动脉峡部内径/动脉导管弓内径具有较高诊断效能。胎儿心脏检查可为临床预测FGR提供有效依据。

To preliminarily investigate the predictive value of fetal cardiac parameters for fetal growth restriction (FGR).

A total of 50 pregnant women who underwent fetal echocardiography during the late gestational period and were clinically suspected of having FGR (observation group) at the Second Affiliated Hospital of Wenzhou Medical University from January 2018 to April 2022 were enrolled in the study, and 56 normal pregnant women who underwent fetal heart examination during the same time period were selected as controls. Pregnant women with suspected FGR were divided into two subgroups based on postnatal neonatal body weight: FGR-confirmed group and FGR-improved group. Fetal growth and umbilical artery, middle cerebral artery, and aortic isthmus blood flow were recorded. Fetal cardiac parameters were obtained, including right atrial transverse diameter, left atrial transverse diameter, left ventriclular transverse diameter, right ventriclular transverse diameter, pulmonary artery diameter, aorta diameter, aorta isthmus diameter, ductus arteriosus arch diameter, right atrial transverse diameter/left atrial transverse diameter ratio, right ventricular transverse diameter/left ventricular transverse diameter ratio, left ventricular spherical index, right ventricular spherical index, left ventricular spherical index/right ventricular spherical index ratio, aortic diameter/pulmonary artery diameter ratio, and aorta isthmus diameter/ductus arteriosus arch diameter ratio. The basic information of the pregnant women as well as the information on the delivery and outcome of the pregnancy was also recorded. Analysis of variance or the Kruskal-Wallis rank test was used to compare the above parameters among the FGR-confirmed group, FGR-improved group, and control group. Further pairwise comparisons between groups were performed by the LSD-t test or Bonferroni method. Spearman correlation analysis was used to assess the correlation between each parameter and FGR-confirmed group and FGR-improved group. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the efficacy of each parameter in diagnosing FGR.

The FGR-confirmed group had significantly higher right atrial transverse diameter/left atrial transverse diameter ratio [1.27 (1.10, 1.44) vs 1.09 (1.00, 1.20), Z=2.581, P=0.030], and significantly lower values of aortic isthmus diameter, aortic isthmus diameter/arterial ductal arch diameter ratio, and left ventricular spherical index/right ventricular spherical index ratio [2.80 (2.50, 3.25) mm vs 3.50 (3.03, 3.78) mm, Z=-3.673, P=0.001; 0.73±0.18 vs 0.96±0.19, t=-5.043, P<0.001; 0.72±0.11 vs 0.80±0.11, t=-2.255, P=0.026] than the FGR-improved group. Compared with the control group, the aortic isthmus diameter [2.80 (2.50, 3.25) mm vs 3.30 (3.00, 3.80) mm, Z=-3.991, P<0.001], aortic isthmus diameter/arterial ductal arch diameter ratio (0.73±0.18 vs 1.00±0.12, t=-7.143, P<0.001), left ventricular spherical index/right ventricular spherical index ratio (0.72±0.11 vs 0.83±0.14, t=-3.904, P<0.001), and left atrial transverse diameter [11.0 (10.0, 12.0) mm vs 12.0 (11.0. 13.0) mm, Z=-2.624, P=0.026] were significantly lower, while the right atrial transverse diameter/left atrial transverse diameter ratio [1.27 (1.10 , 1.44) vs 1.00 (1.00, 1.10), Z=4.959, P<0.001], right atrial transverse diameter [14.0 (12.5, 16.0) mm vs 12.0 (11.0, 14.0) mm, Z=2.599, P=0.028], right ventricular transverse diameter/left ventricular transverse diameter ratio [1.12 (1.04, 1.32) vs 1.00 (0.93, 1.10), Z=3.591, P=0.001], right ventricular sphericity index [0.62 (0.58, 0.71) vs 0.58 (0.52, 0.65), Z=2.530, P=0.034], and arterial ductal arch diameter [3.90 (3.45, 4.70) mm vs 3.35 (3.08, 3.75) mm, Z=3.722, P=0.001] were signficantly higher in the FGR-confirmed group. In contrast, these parameters were not statistically different between the FGR-improved group and the control group (P>0.05 for all). Correlation analyses showed that body mass index, reverse blood flow in the diastolic phase of the aortic isthmus, abnormal umbilical cord blood flow and/or middle cerebral artery blood flow, premature delivery, emergency cesarean section, and placenta or umbilical cord abnormalities were related to FGR outcome (r=0.306, P=0.036; r=0.587, P<0.001; r=0.450, P=0.001; r=0.542, P<0.001; r=0.421, P=0.002; r=0.365, P=0.010). Gestational diabetes, gestational hypertension, oligohydramnios, and whether FGR was suspected before 32 weeks were not statistically correlated with FGR outcome (P>0.05 for all). In the observation group, the sensitivity of the aortic isthmus diameter/ductus arteriosus arch diameter ratio and aortic isthmus diameter for the diagnosis of FGR was 75% and 83%, the specificity was 72% and 68%, and the area under the ROC curve was 0.81 and 0.77, respectively.

The enlargement of the fetal right heart and the reduction of the diameter of the aortic isthmus are closely related to FGR, which can assist in the diagnosis of FGR. The ratio of the diameter of the aortic isthmus to the diameter of the aortic arch has high diagnostic performance for FGR. Fetal cardiac examination is an effective tool for clinical prediction of FGR.