背景:在过去的几十年中,胎儿心脏病学已显示出快速发展。胎儿超声心动图不仅用于检测结构异常,还用于评估胎儿心脏功能。胎儿心脏功能的评估主要在孕中期和孕中期进行。孕早期结束时胎儿心脏功能的研究尚未得到适当的研究,孕周早期缺乏参考值。
目的:本研究旨在评估在妊娠早期结束时测量胎儿心脏左心室与时间相关的心功能参数是否可行和可重复。如果可能,我们提供了11~13+6孕周这些参数的列线图.
方法:我们于2022年3月至9月进行了一项前瞻性观察研究。该研究在2家医院进行(医院大学Dexeus,巴塞罗那,和医院VITAHS9Octubre,瓦伦西亚,西班牙)。扫描由3名胎儿医学专家进行。排除标准为胎儿心律异常,异常的颈部半透明,异常静脉导管,胎儿畸形,死产,估计胎儿体重<10百分位数,糖尿病,和妊娠期高血压疾病。左心室研究的心功能参数为等体积收缩时间,等体积弛豫时间,弹射时间,灌装时间,周期时间,心肌性能指标,射血时间分数,和填充时间分数。我们使用类间相关系数研究了这些参数的可行性以及观察者内和观察者间的可重复性。创建列线图并计算不同参数的值的百分位数。
结果:共招募了409例病例,但一旦应用排除标准,只有296例可以纳入统计分析。观察者内部可重复性研究非常好(类间相关系数>0.900),观察者间可重复性研究良好(类间相关系数>0.700)。数据回归分析表明,灌装时间,等体积收缩时间,充盈时间分数随着胎龄的增加而增加,而射血时间分数随胎龄和心肌表现指数而降低(平均值,0.43±0.08),等体积弛豫时间(平均值,0.04±0.01),和弹射时间(平均,0.16±0.01)从11到13周保持不变。
结论:在11~13+6孕周对胎儿心功能的研究是可行和可重复的。提供了所研究参数的列线图。
BACKGROUND: Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks.
OBJECTIVE: This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks.
METHODS: We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated.
RESULTS: A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks.
CONCLUSIONS: The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.