Curvas de referência dos escores Z dos parâmetros biométricos de corações fetais
Data
2024-10-07
Autores
Vieira, Márcio Fragoso 
Orientadores
Araujo Júnior, Edward
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: determinar equações para cálculo do escores Z de estruturas cardíacas fetais entre 18 e 34 semanas de gestação. Construir tabelas e curvas de referência de percentis das estruturas estudadas. Avaliar a reprodutibilidade intra e interobservador das medidas obtidas. Método: foi realizado um estudo prospectivo transversal envolvendo 340 fetos de gestações únicas entre 18 e 34 semanas de idade gestacional (IG). Avaliaram-se 19 estruturas cardíacas: diâmetro do anel da valva mitral, tricúspide, aórtica e pulmonar; comprimento, diâmetro e área dos ventrículos esquerdo e direito; área e circunferência cardíaca; diâmetro da aorta ascendente, istmo aórtico, tronco pulmonar, artéria pulmonar direita, artéria pulmonar esquerda e ducto arterioso. Realizou-se análise de regressão determinando-se equações para média e desvio-padrão (DP) de todas as estruturas utilizando como variáveis independentes a IG, diâmetro biparietal (DBP) e comprimento do fêmur (CF). Resultados: todas as equações obtiveram altos coeficientes de determinação (R²). O melhor desempenho foi utilizando-se a IG (R² 0,819 a 0,944), seguido pelo CF (R² 0,813 a 0,937) e DBP (R² 0,792 a 0,934). A estrutura que demonstrou maior R² foi circunferência cardíaca e a menor, o ducto arterioso. Criaram-se tabelas de referência dos percentis 2,5, 5, 10, 50, 90, 95 e 97,5 e curvas de referência dos percentis 5, 10, 50, 90 e 95 para todas as estruturas cardíacas em função da IG. Todas as medidas demonstram boa a excelente reprodutibilidade com coeficiente de correlação intraclasse (CCI) interobservador de 0,774 a 0,972 e intraobservador de 0,938 a 0,993. Conclusões: produziram-se equações para o cálculo dos escores Z, além de tabelas e curvas de percentis para 19 estruturas cardíacas fetais. Todas as medidas demonstraram boa reprodutibibilidade.
Objectives: to determine equations for calculating the Z-scores of fetal cardiac structures between 18 and 34 weeks of gestation. To create percentile reference tables and curves for the structures. To assess the intra- and inter-observer reproducibility of the measurements. Methods: a prospective and cross-sectional study was conducted involving 340 fetuses from singleton pregnancies between 18 and 34 weeks of gestational age (GA). Nineteen cardiac structures were evaluated: diameter of the mitral, tricuspid, aortic and pulmonary valve annulus; length, diameter and area of the left and right ventricles; cardiac area and circumference; diameter of the ascending aorta, aortic isthmus, main pulmonar artery, right pulmonary artery, left pulmonary artery, and ductus arteriosus. Regression analysis was performed by determining equations for the mean and standard deviation (SD) of all structures using GA, biparietal diameter (BPD) and fêmur length (FL) as independent variables. Results: all equations obtained high coefficients of determination (R²). The best performance was using GA (R² 0.819 to 0.944), followed by FL (R² 0.813 to 0.937), and BPD (R² 0.792 to 0.934). The structure that demonstrated the highest R² was cardiac circumference and the smallest was the ductus arteriosus. Reference tables of percentiles 2.5, 5, 10, 50, 90, 95 and 97.5 and reference curves of percentiles 5, 10, 50, 90 and 95 were created for all cardiac structures depending on GA. All measurements demonstrated good and excellent reproducibility with an inter-observer intraclass correlation coefficient (ICC) of 0.774 to 0.972 and intra-observer ICC of 0.938 to 0.993. Conclusions: equations were produced to calculate Z-scores, as well as percentile tables and curves for 19 fetal heart structures. All measurements demonstrated good reproducibility.
Objectives: to determine equations for calculating the Z-scores of fetal cardiac structures between 18 and 34 weeks of gestation. To create percentile reference tables and curves for the structures. To assess the intra- and inter-observer reproducibility of the measurements. Methods: a prospective and cross-sectional study was conducted involving 340 fetuses from singleton pregnancies between 18 and 34 weeks of gestational age (GA). Nineteen cardiac structures were evaluated: diameter of the mitral, tricuspid, aortic and pulmonary valve annulus; length, diameter and area of the left and right ventricles; cardiac area and circumference; diameter of the ascending aorta, aortic isthmus, main pulmonar artery, right pulmonary artery, left pulmonary artery, and ductus arteriosus. Regression analysis was performed by determining equations for the mean and standard deviation (SD) of all structures using GA, biparietal diameter (BPD) and fêmur length (FL) as independent variables. Results: all equations obtained high coefficients of determination (R²). The best performance was using GA (R² 0.819 to 0.944), followed by FL (R² 0.813 to 0.937), and BPD (R² 0.792 to 0.934). The structure that demonstrated the highest R² was cardiac circumference and the smallest was the ductus arteriosus. Reference tables of percentiles 2.5, 5, 10, 50, 90, 95 and 97.5 and reference curves of percentiles 5, 10, 50, 90 and 95 were created for all cardiac structures depending on GA. All measurements demonstrated good and excellent reproducibility with an inter-observer intraclass correlation coefficient (ICC) of 0.774 to 0.972 and intra-observer ICC of 0.938 to 0.993. Conclusions: equations were produced to calculate Z-scores, as well as percentile tables and curves for 19 fetal heart structures. All measurements demonstrated good reproducibility.
Descrição
Citação
VIEIRA, Márcio Fragoso. Curvas de referência dos escores z dos parâmetros biométricos de corações fetais. 2024. 138 f. Tese (Doutorado em Obstetrícia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2024.