Improved detection of coarctation of the aorta using speckle-tracking analysis of fetal heart on last examination prior to delivery
Improved detection of coarctation of the aorta using speckle-tracking analysis of fetal heart on last examination prior to delivery
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DOI：
10.1002/uog.21989
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发表时间：
2021-02-01
影响因子：
7.1
通讯作者：
Cuneo, B. F.
中科院分区：
文献类型：
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作者：
DeVore, G. R.;Haxel, C.;Cuneo, B. F.
目的产前诊断主动脉缩窄（FP-CoA）的假阳性率通常超过50%，而准确检出率<50%。本研究旨在确定是否可以通过评估四腔视图（4CV）中的胎儿心外膜大小和形状以及右心室（RV）和左心室（LV）大小来提高产前检测真实CoA和FP-CoA率的灵敏度，方法回顾性分析2000年10月至2004年12月在美国医学数字成像与通信标准（DICOM）来自分娩前最后一次检查的4CV片段，在一系列的108个胎儿中，由儿科心脏病专家使用传统诊断标准在产前怀疑患有CoA。出生后评价区分了随后需要CoA手术的胎仔（真阳性;真CoA）和FP-CoA胎仔。确定每组的出生后心脏异常。为了进行产前评估，我们测量了4CV舒张末期心外膜面积、周长、长度、宽度和球形指数。斑点追踪分析用于计算内径RV和LV舒张末期面积、长度、24节段球形指数、24节段横向宽度以及以下功能参数：面积变化分数;整体纵向、游离壁和室间隔壁应变;基底-心尖长度、基底游离壁和基底室间隔壁缩短分数;室间隔壁环形平面收缩期偏移; 24节段横向宽度缩短分数;以及LV舒张末期和收缩末期容积、每搏输出量、心输出量和射血分数。此外，计算RV/LV舒张末期面积比。使用200只正常胎仔的对照组，使用上述每个心脏测量值的平均值和SD计算108只研究胎仔中每个测量值的Z评分。Logistic回归分析，然后进行Z-评分值，以确定变量，分离的真实CoA组FP-CoA group.Results的108个研究胎儿，54个被证实产后有真实CoA和54 FP-CoA。80%（n = 43）的真CoA胎仔和76%（n= 41）的FP-CoA胎仔存在右/左面积比例失调>第90百分位数。与FP-CoA胎儿（61%，n= 33）相比，具有真实CoA的胎儿具有显著更多的相关心脏异常（93%，n= 50）（P < 0.001）。最常见的合并畸形为二叶式主动脉瓣（真实CoA，46%（n = 25）vs FP-CoA，22%（n=12; P < 0.01），主动脉弓发育不良（真实CoA，31%（n=17）vs FP-CoA，11%（n = 6）; P < 0.01），室间隔缺损，二尖瓣病变（真性CoA，33%（n=18）vs FP-CoA，11%（n = 6）; P < 0.05）（真性CoA，30%（n =16）vs FP-CoA，4%（n = 2）; P < 0.01）。Logistic回归分析确定了28个变量，正确识别96%（52/54）的真正CoA胎儿，假阳性率为4%（2/54），假阴性率为4%（2/54）。这些变量包括4CV的心外膜大小、RV和LV的大小和形状以及RV和LV的异常收缩力。受试者工作特征曲线下面积为0.98（SE，0.023; 95%CI，0.84-1）。有没有显着差异的百分比与CoA和FP-CoA之间的胎儿RV/LV面积比例失调。结论斑点追踪分析的多个心室测量可能有助于提高产前诊断疑似CoA的胎儿。(C)2020年国际妇产科超声学会。
Objective The false-positive rate for prenatal diagnosis of coarctation of the aorta (FP-CoA) commonly exceeds 50%, with an accurate detection rate of < 50%. This study was conducted to determine if the sensitivity for prenatal detection of true CoA and the FP-CoA rate could be improved by evaluating the fetal epicardial size and shape in the four-chamber view (4CV) and the endocardial right (RV) and left (LV) ventricular size, shape and contractility.Methods We analyzed retrospectively Digital Imaging and Communications in Medicine (DICOM) clips of the 4CV from the last examination prior to delivery in a series of 108 fetuses with CoA suspected prenatally by pediatric cardiologists using traditional diagnostic criteria. Postnatal evaluation distinguished those fetuses which subsequently required CoA surgery (true positives; true CoA) from those that were FP-CoA. Postnatal cardiac abnormalities were identified for each group. For the prenatal evaluation, we measured the 4CV end-diastolic epicardial area, circumference, length, width and global sphericity index. Speckle-tracking analysis was used to compute the endocardial RV and LV end-diastolic area, length, 24-segment sphericity index, 24-segment transverse width and the following functional parameters: fractional area change; global longitudinal, free-wall and septal-wall strain; basal-apical-length, basal free-wall and basal septal-wall fractional shortening; septal-wall annular plane systolic excursion; 24-segment transverse-width fractional shortening; and LV end-diastolic and end-systolic volumes, stroke volume, cardiac output and ejection fraction. In addition, the RV/LV end-diastolic area ratio was computed. Using a control group of 200 normal fetuses, the mean and SD for each of the above cardiac measurements was used to compute the Z-scores for each measurement in each of the 108 study fetuses. Logistic regression analysis was then performed on the Z-score values to identify variables that separated the true CoA group from the FP-CoA group.Results Of the 108 study fetuses, 54 were confirmed postnatally to have true CoA and 54 were FP-CoA. Right/left area disproportion > 90th centile was present in 80% (n = 43) of the true-CoA fetuses and 76% (n=41) of the FP-CoA fetuses. Fetuses with true CoA had a significantly greater number of associated cardiac abnormalities (93%, n= 50) compared with the FP-CoA fetuses (61%, n= 33) (P < 0.001). The most common associated malformations were bicuspid aortic valve (true CoA, 46% (n = 25) vs FP-CoA, 22% (n=12); P < 0.01), aortic arch bypoplasia (true CoA, 31% (n=17) vs FP-CoA, 11% (n = 6); P < 0.01), ventricular septal defect (true CoA, 33% (n=18) vs FP-CoA, 11% (n = 6); P < 0.05) and mitral valve abnormality (true CoA, 30% (n =16) vs FP-Co A, 4% (n = 2); P < 0.01). Logistic regression analysis identified 28 variables that correctly identified 96% (52/54) of the fetuses with true CoA, with a false-positive rate of 4% (2/54) and a false-negative rate of 4% (2/54). These variables included the epicardial size in the 4CV, size and shape of RV and LV, and abnormal contractility of RV and LV. The area under the receiver-operating-characteristics curve was 0.98 (SE, 0.023; 95% CI, 0.84-1). There was no significant difference in the percent of fetuses with RV/LV area disproportion between those with CoA and those that were FP-CoA.Conclusions Speckle-tracking analysis of multiple ventricular measurements may be helpful to refine the diagnosis in fetuses that are suspected to have CoA prenatally. (C) 2020 International Society of Ultrasound in Obstetrics and Gynecology.