Theresa M Kühle, Angela Burgmair, Georg Schummers, Mareike Möllers, Kathrin Oelmeier, Chiara De Santis, Helen Ann Köster, Ute Möllmann, Daniela Willy, Janina Braun, Felix Albert, Ralf Schmitz
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Using 2D Cardiac Performance Analysis software (TOMTEC, Unterschleissheim, Germany) we measured global longitudinal strain (GLS). TOMTEC PS detected annular displacement by assessing an artificial M-mode on the previously generated tracking. Dyssynchrony (DYS) was calculated as the inter- and intraventricular difference in time to peak GLS or annular displacement.</p><p><strong>Results: </strong>Greater DYS was observed in all basal myocardial measurement sites and software between FDM-cohort compared to FC-cohort and no significant correlation was found between DYS measurements and gestational age. Intraventricular DYS between the basal segments was statistically significant (all p ≤ 0.036, Wald test of univariate regression models). The PS performed best in DYS measurements identifying right ventricular DYS as potentially predicting FDM (FDM: median, 18.5 (interquartile range [IQR], 13.9-25.0) ms vs. FC: median, 2.7 [IQR, 1.5-3.5] ms; p < 0.001).</p><p><strong>Conclusion: </strong>Increased intraventricular DYS demonstrated an impact of maternal diabetes mellitus on fetal hearts independent of gestational age. The prototype M-mode method identified cardiac dysfunction with higher accuracy than the conventional analysis. 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引用次数: 0
摘要
研究目的本研究旨在利用二维斑点追踪超声心动图（2D-STE）和新型 M 型原型软件（PS）研究糖尿病母亲（FDM）和胎儿对照组（FC）胎儿的非同步性心力衰竭：在这项队列研究中，分析了 174 个胎儿，其中 87 个是 FDM 队列中的胎儿，87 个是 FC 队列中与胎龄匹配的胎儿。38 个胎儿组成最终病例组，中位帧频高达约 160 帧/秒。我们使用二维心脏性能分析软件（TOMTEC，德国，Unterschleissheim）测量了整体纵向应变（GLS）。TOMTEC PS 通过对先前生成的跟踪数据进行人工 M 模式评估来检测瓣环位移。不同步（DYS）是根据 GLS 或瓣环位移达到峰值的时间在心室间和心室内的差异计算得出的：结果：与FC队列相比，在FDM队列的所有基底心肌测量部位和软件中都观察到了更大的不同步性，而且在不同步性测量与胎龄之间没有发现显著的相关性。基底段之间的室内 DYS 有统计学意义（所有 p ≤ 0.036，单变量回归模型的 Wald 检验）。PS在DYS测量中表现最佳，确定右心室DYS可预测FDM（FDM：中位数，18.5（四分位距[IQR]，13.9-25.0）毫秒；FC：中位数，2.7[IQR，1.5-3.5]毫秒；P＜0.001）：结论：室间隔内DYS增加表明母体糖尿病对胎儿心脏的影响与胎龄无关。原型 M 型方法识别心脏功能障碍的准确性高于传统分析方法。高质量的超声心动图图像采集对于二维 STE 及相关先进技术的临床应用至关重要。
Dyssynchronous Fetal Heart Failure in Maternal Diabetes: Evaluation with Speckle Tracking Echocardiography and Novel M-Mode Software.
Objectives: This study aimed to investigate dyssynchronous heart failure in fetuses of mothers with diabetes mellitus (FDM) and fetal controls (FC) using two-dimensional speckle tracking echocardiography (2D-STE) and novel M-mode prototype software (PS).
Methods: In this cohort study 174 fetuses were analyzed, 87 in the FDM-cohort and 87 gestational age-matched fetuses in the FC-cohort. A subgroup of 38 fetuses formed the final case group, with a high median frame rate of approximately 160 frames/s. Using 2D Cardiac Performance Analysis software (TOMTEC, Unterschleissheim, Germany) we measured global longitudinal strain (GLS). TOMTEC PS detected annular displacement by assessing an artificial M-mode on the previously generated tracking. Dyssynchrony (DYS) was calculated as the inter- and intraventricular difference in time to peak GLS or annular displacement.
Results: Greater DYS was observed in all basal myocardial measurement sites and software between FDM-cohort compared to FC-cohort and no significant correlation was found between DYS measurements and gestational age. Intraventricular DYS between the basal segments was statistically significant (all p ≤ 0.036, Wald test of univariate regression models). The PS performed best in DYS measurements identifying right ventricular DYS as potentially predicting FDM (FDM: median, 18.5 (interquartile range [IQR], 13.9-25.0) ms vs. FC: median, 2.7 [IQR, 1.5-3.5] ms; p < 0.001).
Conclusion: Increased intraventricular DYS demonstrated an impact of maternal diabetes mellitus on fetal hearts independent of gestational age. The prototype M-mode method identified cardiac dysfunction with higher accuracy than the conventional analysis. High-quality echocardiographic image acquisition is imperative for clinical application of 2D-STE and related advanced technologies.
期刊介绍：
Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions that demonstrate a novel application of an existing ultrasound technology in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological systems, including bioeffects. Papers that simply utilize standard diagnostic ultrasound as a measuring tool will be considered out of scope. Extended critical reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, book reviews, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community.
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