Evaluation of cardiac findings using speckle-tracking echocardiography in fetuses with hemoglobin Bart's disease.

IF 6.1 1区 医学 Q1 ACOUSTICS Ultrasound in Obstetrics & Gynecology Pub Date : 2024-12-01 DOI:10.1002/uog.27676
S Anuwutnavin, K Russameecharoen, P Ruangvutilert, S Viboonchard, C Yaiyiam, M Sklansky, G R DeVore
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Abstract

Objective: Hemoglobin (Hb) Bart's disease is a severe manifestation of alpha-thalassemia, resulting in fetal tissue hypoxia and severe anemia. There is limited research available on assessing speckle-tracking analysis of the fetal heart as a response to fetal anemia caused by Hb Bart's disease. This study aimed to assess the diagnostic performance of fetal cardiac measurements derived from speckle-tracking analysis to identify fetuses with Bart's anemia between 17 and 24 weeks of gestation.

Methods: This prospective cohort study included 115 women with singleton pregnancies at risk for fetal Hb Bart's disease who underwent either amniocentesis or cordocentesis at Siriraj Hospital, Bangkok, Thailand, in the period between January 2019 and January 2021. Speckle-tracking analysis of the fetal heart was performed in the four-chamber view (4CV), assessing ventricular size and shape, ventricular contractility and left ventricular function, prior to invasive prenatal testing. Logistic regression analysis was used to determine significant cardiac predictors and calculate the probability of a fetus having Hb Bart's anemia.

Results: Among the cohort, 38 (33.0%) fetuses were diagnosed with Hb Bart's disease, and of these, nine (23.7%) cases exhibited fetal hydrops. In comparison to the control group, affected fetuses displayed enlargement of the 4CV, with a globular shape of the right ventricular chamber. Additionally, there were significant reductions in both global and longitudinal left ventricular contractility in non-hydropic affected fetuses compared with the controls. At mid-gestation, no significant differences were observed in transverse contractility or left ventricular function, except for the ejection fraction, between the two groups. Based on logistic regression analysis, combined cardiac measurements derived from speckle-tracking analysis, as a function of head circumference, could differentiate non-hydropic fetuses with Hb Bart's anemia from unaffected fetuses, achieving a sensitivity of 100%, specificity of 98.7% and overall accuracy of 99.1%.

Conclusions: Speckle-tracking analysis of the fetal heart has the potential to accurately identify early fetal cardiac changes during the second trimester in individuals with Bart's anemia. These findings not only offer a novel predictive marker for Hb Bart's anemia, but also help address the question of the underlying mechanisms of heart failure associated with fetal anemia. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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利用斑点追踪技术评估血红蛋白巴特氏症胎儿的心脏检查结果。
目的:血红蛋白(Hb)巴特氏病是α地中海贫血的一种严重表现,会导致胎儿组织缺氧和严重贫血。目前关于评估胎儿斑点追踪分析对血红蛋白巴特氏病引起的胎儿贫血的反应及其作为血红蛋白巴特氏病超声预测指标的实用性的研究还很有限。本研究旨在评估斑点追踪超声心动图得出的胎儿心脏参数的诊断性能,以区分17-24孕周Hb Bart's病风险孕妇中受影响和未受影响的胎儿:共纳入了115名在泰国曼谷Siriraj医院接受羊膜穿刺术或脐带穿刺术的高危孕妇。在有创产前检查前,对胎儿心脏四腔切面(4CV)进行斑点追踪分析,评估心脏大小、形状、心室收缩力和左心室功能。逻辑回归分析确定了重要的心脏预测因素,并计算了胎儿患 Hb Bart 病的概率:结果:在队列中,38 个胎儿(33%)被诊断为 Hb Bart's病,9 个病例(7.8%)表现出明显的水肿征象。与对照组相比,患病胎儿的 4CV 明显增大,尤其是右心室腔呈球状。此外,受影响胎儿与未受影响胎儿的左心室整体收缩力和纵向收缩力存在显著差异。然而,在妊娠中期,两组胎儿的横向收缩力和左心室功能没有明显差异。根据逻辑回归分析,斑点追踪分析得出的综合心脏参数作为头围的函数,可将患有 Hb Bart 病的非水肿胎儿与未受影响的胎儿区分开来,其最大灵敏度为 100%,特异性为 98.7%,总体准确率为 99.06%:结论:斑点追踪超声心动图有可能在妊娠后三个月准确识别有患巴特氏贫血风险的胎儿的早期心脏变化。这不仅为Hb巴特氏病提供了一种新的预测标志物,还有助于解决与贫血相关的心力衰竭的潜在机制问题。本文受版权保护。保留所有权利。
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
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.
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