Arterial Structure and Stiffness Are Altered in Young Adults Born Preterm

Abstract

Objective: Preterm birth has been associated with changes in arterial structure and function. Association with complications occurring during the neonatal period, including bronchopulmonary dysplasia, on vascular outcomes in adulthood is unknown. Approach and Results: We evaluated a cohort of 86 adults born preterm (below 30 weeks of gestation), compared to 85 adults born term, at a mean age of 23 years. We performed ultrasonographic assessment of the dimensions of the ascending aorta, carotid and brachial arteries, and estimated flow-mediated dilation, carotid-femoral pulse wave velocity, augmentation index corrected for heart rate, and carotid intima-media thickness. All analyses were performed with and without adjustment for potential confounding variables, including height, sex, and body mass index. Ascending aorta diameter in diastole was smaller in the preterm group, but carotid and brachial arteries were similar. Carotid and brachial strain, a marker of arterial distensibility, was smaller in the preterm group, while carotid-femoral pulse wave velocity, was similar between groups, indicating similar aortic stiffness. Carotid intima-media thickness, endothelial function flow-mediated dilation, blood nitrite, and nitrate levels were similar between groups. Individuals with bronchopulmonary dysplasia had lower brachial artery strain suggesting long-term association of this neonatal complication with vascular structure. Diastolic blood pressure was higher in the preterm group and was associated with decreased brachial and carotid distensibility. Conclusions: Young adults born preterm display alterations in arterial distensibility that are associated with a history of bronchopulmonary dysplasia.

Vascular Endothelial Function Assessed by Flow-Mediated Vasodilatation in Young Adults Born Very Preterm or With Extremely Low Birthweight: A Regional Cohort Study

“…The subjects who did not participate had a slight and non-significant lower mean birthweight (896 g vs. 961 g, p = 0.08), and a higher occurrence of moderate or severe bronchopulmonary dysplasia (63) compared with the PB/ELBWs who participated. Flahault et al described an association between bronchopulmonary dysplasia and altered elastic properties of the brachial artery, but found no similar association with impaired FMD (28). The possible selection bias could, however, most likely lead to an underestimation of the difference in FMD between the PB/ELBW and the control group.…”

“…Previous studies of endothelial function in children and young adults born preterm or with LBW have presented diverging results, with findings of normal as well as reduced endothelial function (17,(24)(25)(26)(27)(28). Only a few studies have included young adults born extremely preterm or with extremely low birthweight (ELBW) (<1,000 g).…”

Cardiovascular impact and sequelae of bronchopulmonary dysplasia

“…However, studies on the effects of BPD specifically suggest those with BPD may have a stiffer and less developed systemic vascular tree into adulthood. Among young adults born extremely preterm, aortic augmentation index and arterial strain, markers of vascular stiffness and distensibility, were elevated in those with a history of BPD 118,119 . These parameters seem to track over time, suggesting that high‐risk individuals could be identified even in childhood, though currently specific guidelines for diagnostic evaluation or intervention beyond routine blood pressure screening are lacking 118,120 …”

Postnatal Expression Profile of MicroRNAs Associated with Cardiovascular Diseases in 3- to 11-Year-Old Preterm-Born Children

“…In addition, narrower abdominal aortas and lower abdominal aortic stiffness were detected together with higher brachial and aortic blood pressures [24]. Besides, lower left ventricular longitudinal shortening and systolic tissue velocity [12], higher transversal shortening fraction [12], lower atrial emptying velocities [12], higher right ventricular myocardial performance index (RVmpi') [51], elevated aortic wave reflection [14], decreased carotid and brachial distensibility [18], and higher estimated pulmonary vascular resistance (PVR) [51] were found in children, adolescents, and young preterm-born adults.…”

“…Moreover, children, adolescents, or young preterm-born adults were reported to have alterations in both left heart and right heart structure, geometry, and function and alterations in arterial structure and distensibility. Smaller left ventricles [9,12,50], smaller right atria [51], smaller right ventricles [51,52], greater right and left ventricular mass [50,52], smaller ascending aorta diameter [9,18], and higher relative wall thickness [51] were observed in children, adolescents, and young adults born preterm. In addition, narrower abdominal aortas and lower abdominal aortic stiffness were detected together with higher brachial and aortic blood pressures [24].…”