Establishment Z-scores Of Multiple Parameters Of Cardiovascular System Via Echocardiography In Fetal

Congenital heart disease is the leading cause of infant death,the early detection of fetal cardiovascular anomalies diameters by prenatal ultrasound screening of fetal cardiovascular system can aid in improving the prenatal and postnatal management, and in developing timely and effective interventions [1], however, due to lack of effective early diagnosis, resulting in most of the inner diameter of the fetus found cardiovascular abnormalities has been advanced. With the development of fetal echocardiography, using Z-scores in the quantitative assessment of diameter values in the pregnancy and development of the fetal cardiovascular(deterioration or improvement) has received increasing attention from domestic and international scholars in recent years. Z-scores is another new quantitative indicator of fetal echocardiography relevant quantitative analysis,it provides a new research direction for assessment severity of pathological changes and individualized diagnosis and the optimum time for treatment. Therefore, it is necessary to further investigate the application value of fetal cardiovascular quantitative Z-scores. Establishing reference values for the normal fetal heart is an important prerequisite for assessing the degree of heart expansion in a clinical setting. This study analyzed data from a large sample size to investigate the correlation between fetal biological parameters and echocardiography measurements in the normal fetal multiple parameters of cardiovascular system to determine a reference range for normal fetal cardiovascular Z-scores to provide the basis for assessment of fetal heart disease.ObjectiveThe aim of this study was to construct Z-scores reference ranges for normal fetal cardiovascular diameters by applying statistical methods between fetal biological growth parameters and echocardiography measurements.Method1. This is a retrospective cross-sectional study of 2,410 cases of normal singleton fetuses at the mid and late pregnancy stages receiving fetal echocardiography come to my hospital from January 2013 to July 2013 were continuously enrolled. Fetal echocardiography was performed on 2,410 fetuses. The pregnant women were aged between 16-48 years with a mean age of 28±4 years. The fetal gestational ages were between 22-38 weeks with a mean age of 26±3 weeks. Fetal left heart and right heart system parameters incorporated into the same standards for the study. Maternal health, no smoking and alcohol history, no high blood pressure, diabetes, heart, liver, kidney and the like history of chronic. After clinical obstetrics and ultrasound detection of fetal have no obvious abnormalities. Determination of fetal growth indicators, measure the biparietal diameter(BPD) and femoral length(FL) of the fetuses; additionally, the gestation age(GA) of the fetuses was calculated based on the menstrual age to obtain normal biological growth parameters. Fetal left heart system echocardiograph measurements included left atrium transverse diameter(LATD), long diameter(LALD), left ventricular transverse diameter(LVTD), long diameter(LVLD), aortic valve annulus diameter(AO), Aortic arch diameter(AO Arch), and descending aorta diameter(DAO). Fetal right heart system echocardiograph measurements included right atrium transverse diameter(RATD), long diameter(RALD), right ventricular transverse diameter(RVTD), long diameter(RVLD), and pulmonary valve annulus diameters(PA).An optimal model was established using BPD, FL, and GA as independent variables and left heart system parameters( LATD, LALD, LVTD, LVLD, AO, AO Arch, DAO) and right heart system parameters(RATD, RALD, RVTD, RVLD, PA) as dependent variables. A correlation between the standard deviation(SD) and the independent variables was assessed. The reference ranges for Z-scores was calculated using formulas and the above statistical dates.2. Statistical analysisApplication SPSS19.0(SPSS, Inc., Chicago, IL, USA) statistical software for statistical analysis, averaged over a period for three consecutive cardiac cycles of each measure. Statistical analysis to determine the best mode and Z-score biological data reference range [2] reference method outlined in Royston and Wright. P<0.05 was considered statistically significant.ResultA linear regression model between fetal left heart system measurements(LALD, LVTD, LVLD, AO, AO Arch, DAO)and fetal biometry(BPD, FL, GA)correlations were excellent, fetal right heart system measurements(RATD, RALD, RVTD, RVLD, PA)and three independent variables correlations were also excellent, there was slight variation in SD for left heart system and right heart system measurements as BPD, FL, GA increased, there are linear regression models between SD of LATD, LALD, LVTD, LVLD, AO, AO Arch, DAO, RATD, RALD, RVTD, RVLD, PA and three independent variables(BPD, FL, GA), then using weighted regression of absolute residuals was used to adjust the SD, constructed regression models,these equations allowing predictive value to be calculated for fetal cardiac dimensions(LATD, LALD, LVTD, LVLD, AO, AO Arch, DAO, RATD, RALD, RVTD, RVLD, PA) from knowledge of BPD, FL, and GA, Z-score was calculated as(actual measurements of the cardiovascular system–predictive value of cardiovascular system) / SD of predictive value.ConclusionThis study performed a statistical analysis of normal fetal biological growth parameters and parameters from fetal cardiovascular system echocardiography measurements to establish reference ranges for normal Z-scores for the inner diameters of the fetal heart. This permits assessment of growth of normal hearts and congenitally complex hearts and able to obtain the overall distribution of fetal cardiovascular meridian relative to limb increasing, in order to improve sensitivity and specificity of screening fetal growth abnormalities.