Differing Impact of Preterm Birth on the Right and Left Atria in Adulthood

Abstract

Background Preterm birth affects 10% of live births and is associated with an altered left ventricular and right ventricular phenotype and increased cardiovascular disease risk in young adulthood. Because left atrial (LA) and right atrial (RA) volume and function are known independent predictors of cardiovascular outcomes, we investigated whether these were altered in preterm‐born young adults. Methods and Results Preterm‐born (n=200) and term‐born (n=266) adults aged 18 to 39 years underwent cardiovascular magnetic resonance imaging. LA and RA maximal and minimal volumes (absolute, indexed to body surface area, and as a ratio to ventricular volumes) were obtained to study atrial morphology, while LA and RA stroke volume, strain, and strain rate were used to assess atrial function. Secondary analyses consisted of between‐group comparisons based on degree of prematurity. Absolute RA volumes and RA volumes indexed to right ventricular volumes were significantly smaller in preterm‐born compared with term‐born adults. In addition, RA reservoir and booster strain were higher in preterm‐born adults, possibly indicating functional compensation for the smaller RA volumes. LA volumes indexed to left ventricular volumes were significantly greater in preterm‐born adults as compared with term‐born adults, although absolute LA volumes were similar between groups. LA and RA changes were observed across gestational ages in the preterm group but were greatest in those born very‐to‐extremely preterm. Conclusions Preterm‐born adults show changes in LA and RA structure and function, which may indicate subclinical cardiovascular disease. Further research into underlying mechanisms, opportunities for interventions, and their prognostic value is warranted.

Birth weight influences cardiac structure, function, and disease risk: evidence of a causal association

“…In a study by Arnott et al , 48 SGA adults had larger LV volumes and lower LVSV compared to individuals of average size for gestational age. Lewandowski et al reported a greater LV mass, smaller chamber volumes, and worse LV strain in individuals with a history of preterm birth compared with controls, 49 findings that were replicated in relation to the atria, 50 in a subsequent study in an adolescent 51 and a further adult cohort. 52 Importantly, these changes are not benign: they have been shown to relate to a reduced myocardial functional reserve and an increase in diffuse myocardial fibrosis.…”

“…Prior observational evidence suggests that preterm-born adults, when exposed to physiologic stress, may exhibit a response of exaggerated contraction, possibly indicating compensation for reductions in volumetric reserve. 50 , 55 …”

Birth Weight Is Associated With Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Outcomes in Adulthood

“…Our findings imply that low birth weight is linked to late‐onset CVD through mechanisms other than CHIP. Previous work has implicated changes in cardiac structure and function, 57 , 58 , 59 , 60 increased oxidative stress levels, 61 renin–angiotensin–aldosterone system imbalance, 62 and augmented systemic inflammation 63 , 64 as possible factors underlying the independent associations of low birth weight with incident CVD in adulthood. In contrast with low birth weight, the associations between high birth weight and late‐onset CVD appear to be predominantly mediated by conventional risk factors.…”

Preterm birth and cardiometabolic health trajectories from birth to adulthood: the Avon Longitudinal Study of Parents and Children

“…A recent systematic review reportied that adverse cardiometabolic consequences may not be limited to estreme and very preterm individuals (<28 and between 28 to 32 weeks respectively), with moderate to late preterm birth (between 32-36 weeks of gestation) also associated with increased risks of hypertension and diabetes (16). More adverse cardiac structure and function in people born preterm compared with terms have been reported (17,18), although studies with more also tend to have more limited sample sizes.…”