Middle cerebral artery velocity time integral as a predictor of fetal anemia using fetal hemoglobin Bart's disease as study model.

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology Pub Date : 2025-03-27 DOI:10.1002/uog.29213

N Parapob, P Jatavan, S Luewan, T Tongsong

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引用次数: 0

Abstract

Objective: To assess the diagnostic performance of middle cerebral artery (MCA) velocity time integral (VTI) in predicting fetal hemoglobin (Hb) Bart's disease.

Methods: This was a secondary analysis of data collected prospectively from pregnant women at risk for fetal Hb Bart's disease assessed at 17-22 weeks' gestation, receiving care at the Maternal-Fetal Medicine Unit, Chiang Mai Hospital, Thailand, between January 2008 and December 2023. Each fetus underwent prenatal measurement of MCA peak systolic velocity (PSV) and MCA-VTI. Final diagnosis of Hb Bart's disease was confirmed by Hb typing of cord blood, obtained by cordocentesis. MCA-PSV and MCA-VTI were evaluated both as absolute values and multiples of median (MoM) normalized for gestational age. Diagnostic performance of MCA-PSV and MCA-VTI for predicting fetal Hb Bart's disease was evaluated and compared using area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity and positive and negative predictive values.

Results: A total of 485 fetuses at risk for Hb Bart's disease (109 affected, 376 unaffected) met the inclusion criteria. Absolute MCA-VTI values were significantly higher in affected compared with unaffected fetuses (7.9 ± 1.8 vs 5.4 ± 1.3; P < 0.001) as were MoM values (1.5 ± 0.3 vs 1.0 ± 0.2; P < 0.001). The diagnostic performance of MCA-VTI was superior to that of MCA-PSV for detecting fetal anemia due to Hb Bart's disease, with AUCs of 0.877 (95% CI, 0.836-0.917) and 0.898 (95% CI, 0.857-0.938) for absolute MCA-VTI values (in cm) and MCA-VTI MoM, respectively, compared with 0.842 (95% CI, 0.795-0.889) and 0.854 (95% CI, 0.809-0.899) for absolute MCA-PSV values (in cm/s) and MCA-PSV MoM, respectively (P < 0.001).

Conclusion: MCA-VTI is more accurate compared with MCA-PSV for predicting fetal Hb Bart's disease, which indirectly reflects anemia. This suggests that MCA-VTI could serve as an alternative or adjunct to MCA-PSV for detecting fetal anemia, particularly in cases of Hb Bart's disease and potentially for other etiologies. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

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以胎儿血红蛋白巴特氏病为研究模型，大脑中动脉流速时间积分作为胎儿贫血的预测因子。

目的：探讨大脑中动脉（MCA）速度时间积分（VTI）对胎儿血红蛋白（Hb） Bart病的诊断价值。方法：这是对2008年1月至2023年12月期间在泰国清迈医院母胎医学部门接受治疗的妊娠17-22周有胎儿Hb Bart病风险的孕妇前瞻性收集的数据的二次分析。每个胎儿都进行了产前MCA峰值收缩速度（PSV）和MCA- vti测量。Hb Bart病的最终诊断是通过脐带血的Hb分型，通过脐带血穿刺获得。对MCA-PSV和MCA-VTI进行绝对值和胎龄标准化中位数（MoM）的倍数评估。通过受体-工作特征曲线下面积（AUC）、敏感性、特异性、阳性预测值和阴性预测值对MCA-PSV和MCA-VTI预测胎儿Hb Bart病的诊断性能进行评价和比较。结果：485例有Hb Bart病风险的胎儿（109例受影响，376例未受影响）符合纳入标准。受影响胎儿的绝对MCA-VTI值明显高于未受影响胎儿(7.9±1.8 vs 5.4±1.3；结论：与MCA-PSV相比，MCA-VTI预测胎儿Hb Bart病更准确，可间接反映贫血。这表明，MCA-VTI可以作为MCA-PSV检测胎儿贫血的替代或辅助手段，特别是在Hb Bart病和其他病因的情况下。©2025国际妇产科超声学会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.