Blunted cardiac output response to exercise in adolescents born preterm

Haraldsdóttir, Kristín; Watson, Andrew; Pegelow, David F.; Palta, Mari; Tetri, Laura H.; Levin, Taylor S.; Brix, Melissa D.; Centanni, Ryan; Goss, Kara N.; Eldridge, Marlowe

doi:10.1007/s00421-020-04480-9

Cited by 20 publications

(21 citation statements)

References 43 publications

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“…However, there are also indications that different organ systems may be involved to different extents in humans born preterm. For example, some studies have reported a lower aerobic capacity despite similar pulmonary function [12]. Haraldsdottir et al [12] and Goss et al [46] suggested that this may be linked to the lower cardiac index at 50% and 100% of maximal workload.…”

Section: Reduced Maximal Aerobic Exercise Capacity: a Problem Of O 2 ...mentioning

confidence: 99%

“…It is estimated that of those individuals born alive, 5-18% are born prematurely [9], which equates to roughly "15 million babies each year" [9]. The potentially deleterious effects of preterm birth on full organ development can impact the cardiovascular, pulmonary and respiratory systems [6,[10][11][12][13][14][15][16][17]. Therefore, aerobic exercise capacity can be limited by a reduced oxygen delivery because of cardiac dysfunction or an impaired oxygen uptake due to lower pulmonary development [12,[18][19][20][21][22][23][24][25], or both.…”

Section: Introductionmentioning

confidence: 99%

“…The potentially deleterious effects of preterm birth on full organ development can impact the cardiovascular, pulmonary and respiratory systems [6,[10][11][12][13][14][15][16][17]. Therefore, aerobic exercise capacity can be limited by a reduced oxygen delivery because of cardiac dysfunction or an impaired oxygen uptake due to lower pulmonary development [12,[18][19][20][21][22][23][24][25], or both. Accordingly, pulmonary issues culminating specifically in lung and breathing difficulties in those born preterm have been cited as affecting their maximal aerobic exercise capacity.…”

Section: Introductionmentioning

confidence: 99%

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RETRACTED ARTICLE: The Effect of Preterm Birth on Maximal Aerobic Exercise Capacity and Lung Function in Healthy Adults: A Systematic Review and Meta-analysis

Gostelow

Stöhr

2022

Sports Med

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Background A negative impact of premature birth on health in adulthood is well established. However, it is not clear whether healthy adults who were born prematurely but have similar physical activity levels compared to adults born at term have a reduced maximal aerobic exercise capacity (maximum oxygen consumption [VO2max]). Objective We aimed to determine the effect of premature birth on aerobic exercise capacity and lung function in otherwise healthy, physically active individuals. Methods A broad literature search was conducted in the PubMed database. Search terms included ‘preterm/premature birth’ and ‘aerobic exercise capacity’. Maximal oxygen consumption (mL/kg/min) was the main variable required for inclusion, and amongst those investigations forced expiratory volume in 1 s (FEV1, % predicted) was evaluated as a secondary parameter. For the systematic review, 29 eligible articles were identified. Importantly, for the meta-analysis, only studies which reported similar activity levels between healthy controls and the preterm group/s were included, resulting in 11 articles for the VO2max analysis (total n = 688, n = 333 preterm and n = 355 controls) and six articles for the FEV1 analysis (total n = 296, n = 147 preterm and n = 149 controls). Data were analysed using Review Manager ( Review Manager. RevMan version 5.4 software. The Cochrane Collaboration; 2020.). Results The systematic review highlighted the broad biological impact of premature birth. While the current literature tends to suggest that there may be a negative impact of premature birth on both VO2max and FEV1, several studies did not control for the potential influence of differing physical activity levels between study groups, thus justifying a focused meta-analysis of selected studies. Our meta-analysis strongly suggests that prematurely born humans who are otherwise healthy do have a reduced VO2max (mean difference: − 4.40 [95% confidence interval − 6.02, − 2.78] mL/kg/min, p < 0.00001, test for overall effect: Z = 5.32) and FEV1 (mean difference − 9.22 [95% confidence interval − 13.54, − 4.89] % predicted, p < 0.0001, test for overall effect: Z = 4.18) independent of physical activity levels. Conclusions Whilst the current literature contains mixed findings on the effects of premature birth on VO2max and FEV1, our focused meta-analysis suggests that even when physical activity levels are similar, there is a clear reduction in VO2max and FEV1 in adults born prematurely. Therefore, future studies should carefully investigate the underlying determinants of the reduced VO2max and FEV1 in humans born preterm, and develop strategies to improve their maximal aerobic capacity and lung function beyond physical activity interventions.

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Section: Reduced Maximal Aerobic Exercise Capacity: a Problem Of O 2 ...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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RETRACTED ARTICLE: The Effect of Preterm Birth on Maximal Aerobic Exercise Capacity and Lung Function in Healthy Adults: A Systematic Review and Meta-analysis

Gostelow

Stöhr

2022

Sports Med

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“…The combination of lower end diastolic volume and stroke volume with preserved ventricular ejection fraction on the left side of the heart [5] and lower end diastolic volume, stroke volume and ventricular ejection fraction on the right side of the heart [4] has previously been reported for the full cohort of 102 preterm-born young adults. This, in combination with impaired LV systolic and impaired RV response to moderate and high intensity physiological stress seen in other preterm populations, suggests a reduction in myocardial functional reserve [36][37][38]. As previously described, these preterm participants have been found to have higher central pulse pressure and systolic blood pressure [4,5].…”

Section: Discussionsupporting

confidence: 58%

The Preterm Heart-Brain Axis in Young Adulthood: The Impact of Birth History and Modifiable Risk Factors

Lapidaire

Clark

Fewtrell

et al. 2021

JCM

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People born preterm are at risk of developing both cardiac and brain abnormalities. We aimed to investigate whether cardiovascular physiology may directly affect brain structure in young adulthood and whether cardiac changes are associated with modifiable biomarkers. Forty-eight people born preterm, followed since birth, underwent cardiac MRI at age 25.1 ± 1.4 years and brain MRI at age 33.4 ± 1.0 years. Term born controls were recruited at both time points for comparison. Cardiac left and right ventricular stroke volume, left and right ventricular end diastolic volume and right ventricular ejection fraction were significantly different between preterm and term born controls and associated with subcortical brain volumes and fractional anisotropy in the corpus callosum in the preterm group. This suggests that cardiovascular abnormalities in young adults born preterm are associated with potentially adverse future brain health. Associations between left ventricular stroke volume indexed to body surface area and right putamen volumes, as well as left ventricular end diastolic length and left thalamus volumes, remained significant when adjusting for early life factors related to prematurity. Although no significant associations were found between modifiable biomarkers and cardiac physiology, this highlights that cardiovascular health interventions may also be important for brain health in preterm born adults.

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“…4 Human studies from birth through to young adulthood have now demonstrated that LV function and structure are altered in individuals born preterm, 3 including an inability to meet the demands of physiologic stress in adolescence and young adulthood. 6,7,19,20 The lower myocardial functional reserve seen in preterm-born young adults in response to acute stress may in part explain why the risk of early heart failure is so much greater in this population. 1,21 Given the underlying morphologic impairments in the preterm heart, it is conceivable that blood pressure elevation would have a greater effect on cardiac remodeling in this population.…”

Section: Extremely and Very Preterm Moderately Preterm Termmentioning

confidence: 99%

Association of Systolic Blood Pressure Elevation With Disproportionate Left Ventricular Remodeling in Very Preterm-Born Young Adults

et al. 2021

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IMPORTANCE Preterm-born individuals have higher blood pressure with an increased risk of hypertension by young adulthood, as well as potentially adverse cardiac remodeling even when normotensive. To what extent blood pressure elevation affects left ventricular (LV) structure and function in adults born preterm is currently unknown. OBJECTIVE To investigate whether changes observed in LV structure and function in preterm-born adults make them more susceptible to cardiac remodeling in association with blood pressure elevation. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional cohort study, conducted at the Oxford Cardiovascular Clinical Research Facility and Oxford Centre for Clinical Magnetic Resonance Research, included 468 adults aged 18 to 40 years. Of these, 200 were born preterm (<37 weeks' gestation) and 268 were born at term (Ն37 weeks' gestation). Cardiac magnetic resonance imaging was used to characterize LV structure and function, with clinical blood pressure readings measured to assess hypertension status. Demographic and anthropometric data, as well as birth history and family medical history information, were collected. Data were analyzed between January 2012 and February 2021. MAIN OUTCOMES AND MEASURESCardiac magnetic resonance measures of LV structure and function in response to systolic blood pressure elevation. RESULTSThe cohort was primarily White (>95%) with a balanced sex distribution (51.5% women and 48.5% men). Preterm-born adults with and without hypertension had higher LV mass index, reduced LV function, and smaller LV volumes compared with term-born individuals both with and without hypertension. In regression analyses of systolic blood pressure with LV mass index and LV mass to end-diastolic volume ratio, there was a leftward shift in the slopes in preterm-born compared with term-born adults. Compared with term-born adults, there was a 2.5-fold greater LV mass index per 1-mm Hg elevation in systolic blood pressure in very and extremely preterm-born adults (<32 weeks' gestation) (0.394 g/m 2 vs 0.157 g/m 2 per 1 mm Hg; P < .001) and a 1.6-fold greater LV mass index per 1-mm Hg elevation in systolic blood pressure in moderately preterm-born adults (32 to 36 weeks' gestation) (0.250 g/m 2 vs 0.157 g/m 2 per 1 mm Hg; P < .001). The LV mass to end-diastolic volume ratio per 1-mm Hg elevation in systolic blood pressure in the very and extremely preterm-born adults was 3.4-fold greater compared with those born moderately preterm (3.56 × 10 −3 vs 1.04 × 10 −3 g/mL per 1 mm Hg; P < .001) and 3.3-fold greater compared with those born at term (3.56 × 10 −3 vs 1.08 × 10 −3 g/mL per 1 mm Hg; P < .001).CONCLUSIONS AND RELEVANCE Preterm-born adults have a unique LV structure and function that worsens with systolic blood pressure elevation. Additional primary prevention strategies specifically targeting cardiovascular risk reduction in this population may be warranted.

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Blunted cardiac output response to exercise in adolescents born preterm

Cited by 20 publications

References 43 publications

RETRACTED ARTICLE: The Effect of Preterm Birth on Maximal Aerobic Exercise Capacity and Lung Function in Healthy Adults: A Systematic Review and Meta-analysis

RETRACTED ARTICLE: The Effect of Preterm Birth on Maximal Aerobic Exercise Capacity and Lung Function in Healthy Adults: A Systematic Review and Meta-analysis

The Preterm Heart-Brain Axis in Young Adulthood: The Impact of Birth History and Modifiable Risk Factors

Association of Systolic Blood Pressure Elevation With Disproportionate Left Ventricular Remodeling in Very Preterm-Born Young Adults

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