The Application Of Tissue Doppler Imaging And Speckle Tracking Imaging In Fetal Cardiac Function Assessment Of Congenital Heart Diseases

Objectives:The aim of this study was to evaluate the valuation of tissue doppler imaging and speckle tracking imaging in fetal cardiac function assessment and compare left heart related congenital heart diseases to right heart related congenital heart diseases in the influence on fetal cardiac function.Methods:We chose 53 cases as research objects,all cases were diagnosed as left or right heart related congenital heart diseases between July,2007 and July,2017 in the First Affiliate Hospital of Kunming Medical University.26 cases were diagnosed as left heart related congenital heart diseases while 27 cases were diagnosed as right heart related congenital heart diseases.We used conventional methods to acquire E wave、A wave、E/A value of mitral valve and tricuspid valve,the mobility of left ventricular posterior wall、interventricular septum and right ventricular anterior wall,ejection fraction(EF)and shortening fraction(SF)of left ventricle and right ventricle,and cardiovascular profile score(CVPS).Tissue Doppler was used to calculate Sm wave、Em wave、Am wave、Em/Am、E/Em and myocardial performance index(MPI).And speckle tracking was used to acquire strain rates(SR)of left ventricle,right ventricle and interventricular septum.Then we compared the differences of all those data between case group and control group,left heart related congenital heart diseases group and right heart related congenital heart diseases group.Results:(1)There was no significant differences between case group and control group in E wave,A wave and E/A value of mitral valve or tricuspid valve(P>0.05).(2)The motilities of left ventricular posterior wall and right ventricular anterior wall measured by M-mode echocardiogram in case group were weaker than those in control group(P<0.05),while the motility of interventricular septum showed no differences between case group and control group(P>0.05).The ejection fraction of both ventricles were stable in case group and control group(P>0.05),but in case group,both ventricular shortening fractions was lower(P<0.05).(3)Em wave and Em/Am value of mitral annulus and tricuspid annulus in case group were lower than those in control group(P<0.05),while E/Em value was higher in case group than that in control group(P<0.05),but there was no significant differences of annular Am wave between case group and control group(P>0.05).C4)The strain rates of left ventricle,right ventricle and interventricular septum measured by speckle tracking showed significant differences between case group and control group,no matter in diastole phase or systole phase(P<0.05).(5)Em/Am value,E/Em value showed no significant differences between the two subgroups(P>0.05).(6)There were no significant differences of strain rates of left ventricle and interventricular septum between subgroups(P>0.05),but strain rates of right ventricle showed significant differences in subgroups(P<0,05).(7)Myocardial performance index of left ventricle showed differences between case group and control group(P<0.05),and it also changed in subgroups(P<0.05),but in right ventricle,it remained stable in subgroups(P>0.05)and only showed differences between case group and control group(P<0.05).(8)In case group,cardiovascular profile score was lower than that in control group(P<0.05),but there was no significant differences between subgroups(P>0.05).Conclusions:Tissue doppler imaging and speckle tracking imaging were more sensitive and reproducible in assessment of fetal cardiac function compared with conventional methods.The influence on regional heart function of right heart related congenital heart diseases was more significant than left heart related congenital heart diseases.In terms of integral heart function,both left heart related congenital heart diseases and right heart related congenital heart diseases could have effects on it,but those effects showed no differences.