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Chinese Journal of Medical Ultrasound (Electronic Edition) ›› 2021, Vol. 18 ›› Issue (08): 771-776. doi: 10.3877/cma.j.issn.1672-6448.2021.08.011

Special Issue:

• Obstetric and Gynecologic Ultrasound • Previous Articles     Next Articles

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 Online:2021-08-01 Published:2021-09-09
  • Contact: Xianfeng Guo

Abstract:

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.

Key words: Ebstein anomaly, Fetus, Tricuspid annular plane systolic excursion, Mitral annular plane systolic excursion, Z-score, Ventricular function

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