左心发育不全综合征围产期心脏功能适应：纵向分析。

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2024-11-01 DOI:10.1016/j.echo.2024.06.020

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引用次数: 0

摘要

背景：围产期过渡期的特点是心脏负荷的急剧变化。与正常新生儿合并心输出量（CCO）相比，左心发育不全综合征（HLHS）新生儿的单个右心室（RV）输出量明显增大。我们试图研究促进HLHS围产期从胎儿晚期向新生儿早期过渡的心脏适应机制：方法：前瞻性招募的胎儿 HLHS 并发症孕妇（35 人）和健康对照组（17 人）分别在妊娠晚期（38±1 周）和出生后 6、24 和 48 小时接受连续超声心动图检查。采用常规、组织多普勒和斑点追踪超声心动图评估心脏功能：结果：足月HLHS胎儿的左心室输出量（RVCO）通过较高的搏出量（SV）与Ctrl CCO相当。与 Ctrl 胎儿的左心室（LV）和 RV 指数相比，他们的 RV 呈球状扩张，相对壁厚（RWT）降低[RWT：0.40±0.08 vs. 0.49±0.10，p2/m2 vs. 15±3cm2/m2/17±5cm2/m2，Tei 指数'：0.65±0.11 vs. 0.65±0.11]：0.65±0.11 vs. 0.43±0.07/0.45±0.09，均为 p结论：足月 HLHS 胎儿表现出 RV 几何形状以及 RV 收缩和舒张功能参数的改变。出生后，这些心脏参数的进一步改变可能反映了对增加的心输出量和肺动脉流量需求所导致的急性 RV 负荷改变的适应。

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Perinatal Cardiac Functional Adaptation in Hypoplastic Left Heart Syndrome: A Longitudinal Analysis

Background

The perinatal transition is characterized by acute changes in cardiac loading. Compared with normal newborn combined cardiac output (CCO), single right ventricular (RV) output of neonates with hypoplastic left heart syndrome (HLHS) is markedly greater. The aim of this study was to examine the mechanisms of cardiac adaptation that facilitate this perinatal transition from late fetal to early neonatal life in HLHS.

Methods

Prospectively recruited pregnancies complicated by fetal HLHS (n = 35) and healthy control subjects (Ctrl; n = 17) underwent serial echocardiography in late gestation (38 ± 1 weeks) and 6, 24, and 48 hours after birth. Cardiac function was assessed using conventional, Doppler tissue, and speckle-tracking echocardiography.

Results

Term fetuses with HLHS had RV output comparable with Ctrl CCO via higher stroke volume. Compared with both left ventricular and RV indices of Ctrl, they exhibited globular and dilated right ventricles with reduced relative wall thickness (0.40 ± 0.08 vs 0.49 ± 0.10, P < .01), increased Tei index′ (HLHS vs Ctrl left ventricle/Ctrl right ventricle: sphericity index, 0.9 ± 0.25 vs 0.5 ± 0.10/0.6 ± 0.11; RV area index, 28 ± 6 vs 15 ± 3/17 ± 5 cm²/m²; Tei index′, 0.65 ± 0.11 vs 0.43 ± 0.07/0.45 ± 0.09; P < .0001 for all). Neonates with HLHS generated elevated RV cardiac output compared with Ctrl CCO via higher heart rate and stroke volume, with further RV dilatation, increased longitudinal systolic strain at 48 hours (−17 ± 4% vs −14 ± 3%/ 14 ± 5%) with reduced circumferential and rotational myocardial deformation and altered diastolic function. Neonates with HLHS also demonstrated right atrial enlargement with increased longitudinal strain: 6 hours (33 ± 12% vs 26 ± 6%), 24 hours (37 ± 15% vs 26 ± 13%), and 48 hours (38 ± 11% vs 24 ± 13%) (P < .0001).

Conclusions

Term fetuses with HLHS exhibit altered RV geometry and RV systolic and diastolic functional parameters. After birth, further alterations in these cardiac parameters likely reflect adaptation to acutely altered RV loading from increasing cardiac output and pulmonary artery flow demands.

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.