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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2024, Vol. 21 ›› Issue (02) : 151 -157. doi: 10.3877/cma.j.issn.1672-6448.2024.02.007

妇产科超声影像学

超声心动图定量右心时间间期在评估右心室流出道梗阻性疾病胎儿右心功能中的应用研究
冯敏1, 赵博文2,†(), 潘美2, 彭晓慧2, 陈冉2, 毛彦恺2, 陈阳2   
  1. 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;310006　杭州，西湖大学附属杭州市第一人民医院超声科
    2. 310016　杭州，浙江大学医学院附属邵逸夫医院超声科　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:2023-07-13 出版日期:2024-02-01
  • 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)

Application of right heart time interval measured using echocardiography in evaluating right heart function in fetuses with right ventricular outflow tract obstruction

Min Feng1, Bowen Zhao2,†(), Mei Pan2, Xiaohui Peng2, Ran Chen2, Yankai Mao2, Yang Chen2   

  1. 1. Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School 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 Ultrasonography, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou 310006, China
    2. Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School 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:2023-07-13 Published:2024-02-01
  • Corresponding author: Bowen Zhao
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引用本文：

冯敏, 赵博文, 潘美, 彭晓慧, 陈冉, 毛彦恺, 陈阳. 超声心动图定量右心时间间期在评估右心室流出道梗阻性疾病胎儿右心功能中的应用研究[J]. 中华医学超声杂志（电子版）, 2024, 21(02): 151-157.

Min Feng, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Yankai Mao, Yang Chen. Application of right heart time interval measured using echocardiography in evaluating right heart function in fetuses with right ventricular outflow tract obstruction[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(02): 151-157.

目的

探讨胎儿超声心动图定量右心时间间期在右心室流出道梗阻性疾病（RVOTO）胎儿右心功能评估中的价值。

方法

这是一项前瞻性研究。纳入2021年2月至2022年8月在浙江大学医学院附属邵逸夫医院超声心动图诊断为RVOTO的胎儿28例（RVOTO组）及同期胎龄匹配的心脏超声检查未见明显异常的胎儿114例（正常组）。胎儿右心功能参数包括M型超声心动图测量三尖瓣环收缩期位移（TAPSE）、组织多普勒（TDI）获取三尖瓣环舒张期流速曲线并测量舒张早期速度（E'）及舒张晚期速度（A'），并计算E'/A'值，同时测量右心等容收缩时间（ICT）、等容舒张时间（IRT）、充盈时间（FT）、射血时间（ET）及心动周期（CT），并通过公式计算胎儿右心的心肌做功指数（RVMPI）、收缩舒张时间指数（SDI）、收缩舒张持续时间比（SDR）、充盈时间分数（FTF）和射血时间分数（ETF）。比较2组间各超声心动图参数，分析其差异性。

结果

RVOTO组IRT平均值为（43.21±4.88）ms，低于正常组（45.71±5.12）ms；RVOTO组ICT平均值为（42.79±5.59）ms，低于正常组（47.82±7.09）ms；RVOTO组胎儿（ICT+IRT）平均值为（87.29±7.78）ms，低于正常组（93.51±10.48）ms；RVOTO组FT平均值为（124.46±4.70）ms，低于正常组（142.00±15.77）ms，以上参数2组间比较差异均有统计学意义（P均<0.05）。RVOTO组胎儿RVMPI指数大于正常组（0.52±0.06 vs 0.48±0.07，P<0.001），RVOTO组SDI大于正常组（2.17±0.18 vs 1.95±0.24，P<0.001），RVOTO组SDR大于正常组（1.35±0.12 vs 1.22±0.12，P<0.001），RVOTO组FTF小于正常组（0.31±0.02 vs 0.34±0.03，P<0.001），三尖瓣环E'值正常组大于RVOTO组（6.38±1.82 vs 5.59±1.96，P<0.001），三尖瓣环E'/A'值正常组大于RVOTO组（0.62±0.11 vs 0.51±0.12，P<0.001）。

结论

胎儿超声心动图定量右心室MPI、SDI、SDR、FTF及三尖瓣环E'值和E'/A'比值有助于对RVOTO胎儿的右心功能进行综合评价，对评估胎儿当前疾病状态及估测预后有潜在的临床应用价值。

关键词: 超声心动图, 右心室流出道梗阻性疾病, 心肌做功指数, 时间间期, 右心功能
Objective

To assess the value of right heart time interval measured by echocardiography in evaluating right heart function in fetuses with right ventricular outflow tract obstruction (RVOTO).

Methods

This prospective study included 28 fetuses diagnosed with RVOTO by echocardiography (RVOTO group) at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and 114 fetuses matched for gestational age with no abnormalities (normal group). Right heart function parameters of all the fetuses were measured, including tricuspid annular plane systolic excursion (TAPSE). Tissue Doppler imaging (TDI) was used to obtain the tricuspid anular velocity curve and to measure the peak velocity (E') in the early diastolic period and the peak velocity (A') in the late diastolic period, and E'/A' ratio was subsequently calculated. Isovolumic contraction time (ICT), isovolumic relaxation time (IRT), filling time (FT), ejection time (ET), and cardiac cycle (CT) were also measured. The myocardial performance index (RVMPI), systolic-to-diastolic time index (SDI), systolic to diastolic duration ratio (SDR), filling time fraction (FTF), and ejection time fraction (ETF) of the fetal right heart were calculated by the formulas. The parameters between the two groups were compared.

Results

The mean values of IRT [(43.21±4.88) ms vs (45.71±5.12) ms, P<0.05], ICT [(42.79±5.59) ms vs (47.82±7.09) ms, P<0.05], (ICT+IRT) [(87.29±7.78) ms vs (93.51±10.48) ms, P<0.05], and FT value [(124.46±4.70) ms vs (142.00±15.77) ms, P<0.05] were significantly shorter in the RVOTO group than in the normal group. The RVMPI (0.52±0.06 vs 0.48±0.07, P<0.001), SDI (2.17±0.18 vs 1.95±0.24, P<0.001), SDR (1.35±0.12 vs 1.22±0.12, P<0.001), and FTF (0.31± 0.02 vs 0.34± 0.03, P<0.001) were significantly higher in the RVOTO group than in the normal group. The values of E' (6.38±1.82 vs 5.59±1.96, P<0.001) and E'/A' ratio (0.62±0.11 vs 0.51±0.12, P<0.001) of the tricuspid annulus were significantly higher in the normal group than in the RVOTO group.

Conclusion

The fetal echocardiographic parameters right ventricular MPI, SDI, SDR, FTF, E' value of tricuspid valve ring, and E'/A' ratio are helpful for comprehensive evaluation of right heart function in fetuses with RVOTO, and have potential clinical value in evaluating fetuses' current disease status and prognosis.

Key words: Echocardiography, Right ventricular outflow tract obstruction, Myocardial performance index, Time interval, Right heart function
图1 脉冲组织多普勒（PW-DTI）测量胎儿右心室三尖瓣前叶瓣环与右心游离壁交界处流速曲线。图a为正常胎儿心尖四腔心切面测量胎儿右心室三尖瓣前叶瓣环与右心游离壁交界处组织多普勒图像；图b为右心室三尖瓣前叶瓣环与右心游离壁交界处组织多普勒时间间期的测量 注：LA左心房；LV左心室；RA右心房；RV右心室；ET射血时间；FT充盈时间；ICT等容收缩时间；IRT等容舒张时间
表1 RVOTO组与正常组胎儿超声心动图右心时间间期及其他心功能参数比较（）
测量参数 RVOTO组（n=28） 正常组（n=114） t值 P值
IRT（ms） 43.21±4.88 45.71±5.12 0.00 0.021
ICT（ms） 42.79±5.59 47.82±7.09 1.70 <0.001
IRT+ICT（ms） 87.29±7.78 93.51±10.48 2.37 <0.001
FT（ms） 124.46±4.70 142.00±15.77 24.73 <0.001
ET（ms） 183.07±16.56 179.64±9.66 16.37 0.301
RVMPI 0.52±0.06 0.48±0.07 0.53 <0.001
SDI 2.17±0.18 1.95±0.24 3.47 <0.001
SDR 1.35±0.12 1.22±0.12 0.05 <0.001
FTF 0.31±0.02 0.34±0.03 3.31 <0.001
ETF 0.45±0.35 0.44±0.27 4.76 0.076
E'（cm/s） 5.59 ±1.96 6.38±1.82 0.23 <0.001
A'（cm/s） 10.63±2.56 10.33±2.02 2.44 0.503
E'/A' 0.51±0.12 0.62±0.11 0.30 <0.001
TAPSE（mm） 6.45±1.19 6.53±1.99 12.10 0.845
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