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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 (04) : 384 -390. doi: 10.3877/cma.j.issn.1672-6448.2024.04.006

妇产科超声影像学

二维斑点追踪技术评价正常中晚孕期胎儿右心房功能的初步研究
张帧1, 赵博文2,†(), 潘美2, 彭晓慧2, 陈冉2, 田园诗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;315099　宁波市第二医院超声诊断中心
    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:2024-01-17 出版日期:2024-04-01
  • 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)

Evaluation of normal fetal right atrial function in the second and third trimester of pregancy by two-dimensional speckle tracking echocardiography: a preliminary study

Zhen Zhang1, Bowen Zhao2,†(), Mei Pan2, Xiaohui Peng2, Ran Chen2, Yuanshi Tian2, Yang Chen2   

  1. 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;Ningbo No. 2 Hospital, Ningbo 315099, China
    2. 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:2024-01-17 Published:2024-04-01
  • Corresponding author: Bowen Zhao
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引用本文：

张帧, 赵博文, 潘美, 彭晓慧, 陈冉, 田园诗, 陈阳. 二维斑点追踪技术评价正常中晚孕期胎儿右心房功能的初步研究[J]. 中华医学超声杂志（电子版）, 2024, 21(04): 384-390.

Zhen Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Yuanshi Tian, Yang Chen. Evaluation of normal fetal right atrial function in the second and third trimester of pregancy by two-dimensional speckle tracking echocardiography: a preliminary study[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(04): 384-390.

目的

应用二维斑点追踪技术（2D-STE）定量正常中晚孕期胎儿右心房应变，评估正常胎儿右心房功能，并分析胎儿右心房应变的可能影响因素及与左心房应变的关联性。

方法

选取2021年11月至2022年3月在浙江大学医学院附属邵逸夫医院接受胎儿超声心动图检查的正常中晚孕胎儿261例，采集标准四腔心观动态图像，脱机应用2D-STE离线分析软件测量胎儿心房整体纵向应变，得出应变曲线及参数。分析胎儿左、右心房应变曲线及应变参数获得情况，正常胎儿右心房应变参数、心率与孕龄的相关性以及应变参数显示率与孕龄、心率、帧频等的关系，并对右心房应变与左心房应变进行比较及相关性分析。

结果

261例胎儿中244例（93%，244/261）成功获得右心房应变曲线。其中131例（54%，131/244）胎儿可识别右心房储存期应变（RASr）、管道期应变（RAScd）及收缩期应变（RASct），并计算管道期与储存期应变之比（RAratio），113例（46%，113/244）胎儿仅识别RASr，未能识别RAScd及RASct。RASr、RASct与孕龄呈弱负相关（r=-0.205，P=0.001；r=-0.235，P=0.007），RAratio与孕龄呈弱正相关（r=0.178，P=0.042）。显示RASct组胎儿的心率低于未显示RASct组[（146.34±8.83）次/min vs（149.67±7.49）次/min，P<0.05]。右心房的3个时相应变值均高于左心房（P均<0.05），且RASr与左心房储存期应变（LASr）（r=0.581，P<0.001），RAScd与左心房管道期应变（LAScd）（r=0.258，P=0.004），RASct与左心房收缩期应变（LASct）（r=0.413，P<0.001）均呈正相关性。

结论

2D-STE在正常胎儿右心房功能评估中具有良好的可行性和可重复性，正常胎儿右心房功能与左心房相似，存在3个时相，并与孕龄存在弱相关性。

关键词: 二维斑点追踪超声心动图, 胎儿, 心房功能，右, 应变
Objective

To quantify the right atrial strain of normal fetuses in the second and third trimester of pregancy by using two-dimensional speckle tracking echocardiography (2D-STE) to evaluate the normal fetal right atrial function, and to analyze the possible influencing factors of fetal right atrial strain and its correlation with left atrial strain.

Methods

A total of 261 normal second- and third-trimester fetuses who underwent fetal echocardiography at Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from November 2021 to March 2022 were selected. The standard four-chamber views were collected. 2D-STE offline analysis software was used to measure the global longitudinal strain of the fetal atrium, and the strain curves and parameters were obtained. The acquisition of fetal left and right atrial strain curves and parameters was analyzed. The correlation between fetal right atrial strain, heart rate, and gestational age, as well as the relationship between the display rate of strain and gestational age, heart rate, and frame rate, was analyzed. The comparison and correlation between right and left atrial strain was analyzed.

Results

Right atrial strain curves were successfully obtained in 244 (93%, 244/261) of the 261 fetuses included. Among them, 131 (54%,131/244) fetuses had detectable right atrial reservoir strain (RASr), conduit strain (RAScd), and contraction strain (RASct), and the ratio of conduit strain to reservoir strain (RAratio) was calculated. In 113 cases (46%, 113/244) fetuses, only RASr, but not RAScd and RASct, could be identified. RASr and RASct had a weak negative correlation with gestational age (r=-0.205, P=0.001; r=-0.235, P=0.007), and RAratio had a weak positive correlation with gestational age (r=0.178, P=0.042). The fetal heart rate in the RASct group was lower than that in the non-RASCT group [(146.34±8.83) beats/min vs (149.67±7.49) beats/min, P<0.05]. The three-phase strain values of the right atrium were higher than those of the left atrium (P<0.05 for all). RASr was positively correlated with left atrial reservoir strain (LASr) (r=0.581, P<0.001), RAScd was positively correlated with left atrial conduit strain (LAScd) (r=0.258, P=0.004), and RASct was positively correlated with left atrial contraction strain (LASct) (r=0.413, P<0.001).

Conclusion

2D-STE has good feasibility and repeatability in assessing right atrial function in normal fetuses. The function of the right atrium in normal fetuses is similar to that of the left atrium, with three phasic strains. Right atrial strain has a weak negative correlation with gestational age.

Key words: Two-dimensional speckle tracking echocardiography, Fetus, Atrial function, right, Strain
图1 胎儿右心房及左心房应变曲线图。图a为四腔心切面右心房壁描记，将舒张末期定为零参考基线，得出右心房应变曲线，获得3个时相，分别为右心房储存期应变（RASr）、右心房管道期应变（RAScd）及右心房收缩期应变（RASct）；图b为左心房壁描记，得出左心房应变曲线，获得3个时相，分别为左心房储存期应变（LASr）、左心房管道期应变（LAScd）及左心房收缩期应变（LASct） 注：RV为右心室；RA为右心房；LV为左心室；LA为左心房
图2 右心房应变分析曲线仅显示储存期应变，未能显示右心房管道期及收缩期应变
图3 胎儿右心房应变参数与孕龄的相关性分析散点图。图a~c分别为右心房储存期应变、右心房管道期应变、右心房收缩期应变的相关性分析散点图，图a、c直线回归方程分别为Y=47.282-0.227X（R2=0.037），Y=30.442-0.261X（R2=0.034）
表1 不同孕龄组胎儿右心房应变参数比较[或M（P25，P75）]
组别 RASr RAScd RASct
例数 测值（%） 例数 测值（%） 例数 测值（%）
18~24周 64 42.06±4.56 36 17.07±5.15 36 25.36±4.87
25~30周 147 40.83±4.42 68 17.97±5.20 68 22.85±5.50
31~38周 33 39.57（37.59，41.25） 27 17.93±4.66 27 22.13±5.32
统计值 H=6.647 F=0.398 F=3.595
P值 0.036 0.673 0.030
表2 显示右心房收缩期应变组与未显示右心房收缩期应变组的孕龄、心率、帧频及RASr比较[或M（P25，P75）]
分组 例数 孕龄（周） 心率（次/min） 帧频（帧/s） RASr（%）
显示右心房收缩期应变 131 27（24，30） 146.34±8.83 183（164, 200） 41.10±4.69
未显示右心房收缩期应变 113 28（25，30） 149.67±7.49 184（165，199） 41.05±4.18
统计值 Z=1.395 t=2.956 Z=0.091 t=0.103
P值 0.163 0.003 0.927 0.918
图4 右心房应变与左心房应变的相关性分析散点图。图a为右心房与左心房储存期应变的相关性分析散点图，直线回归方程为Y=0.457X+16.673（R2=0.335）；图b为右心房与左心房管道期应变的相关性分析散点图，直线回归方程为Y=0.238X+11.964（R2=0.064）；图c为右心房与左心房收缩期应变的相关性分析散点图，直线回归方程为Y=0.371X+10.470（R2=0.163）
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