Preterm Heart in Adult Life

Abstract

Background— Preterm birth leads to an early switch from fetal to postnatal circulation before completion of left ventricular in utero development. In animal studies, this results in an adversely remodeled left ventricle. We determined whether preterm birth is associated with a distinct left ventricular structure and function in humans. Methods and Results— A total of 234 individuals 20 to 39 years of age underwent cardiovascular magnetic resonance. One hundred two had been followed prospectively since preterm birth (gestational age=30.3±2.5 week; birth weight=1.3±0.3 kg), and 132 were born at term to uncomplicated pregnancies. Longitudinal and short-axis cine images were used to quantify left ventricular mass, 3-dimensional geometric variation by creation of a unique computational cardiac atlas, and myocardial function. We then determined whether perinatal factors modify these left ventricular parameters. Individuals born preterm had increased left ventricular mass (66.5±10.9 versus 55.4±11.4 g/m 2 ; P <0.001) with greater prematurity associated with greater mass ( r = −0.22, P =0.03). Preterm-born individuals had short left ventricles with small internal diameters and a displaced apex. Ejection fraction was preserved ( P >0.99), but both longitudinal systolic (peak strain, strain rate, and velocity, P <0.001) and diastolic (peak strain rate and velocity, P <0.001) function and rotational (apical and basal peak systolic rotation rate, P =0.05 and P =0.006; net twist angle, P =0.02) movement were significantly reduced. A diagnosis of preeclampsia during the pregnancy was associated with further reductions in longitudinal peak systolic strain in the offspring ( P =0.02, n=29). Conclusions— Individuals born preterm have increased left ventricular mass in adult life. Furthermore, they exhibit a unique 3-dimensional left ventricular geometry and significant reductions in systolic and diastolic functional parameters. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01487824.

The Preterm Heart in Childhood: Left Ventricular Structure, Geometry, and Function Assessed by Echocardiography in 6‐Year‐Old Survivors of Periviable Births

“…Two previous studies of children7 and adolescents8 concluded that no or only minor cardiovascular effects were associated with extremely preterm birth. In contrast, more profound cardiac changes were reported in young adults, including left ventricular (LV) hypertrophy, altered ventricular shape, and reduced systolic and diastolic functions 4. To some extent, these discrepancies in findings may reflect contributions from perinatal risk factors and exposures besides preterm birth, such as fetal growth restriction and neonatal morbidity.…”

“…Given a relationship between lower gestational age and poorer cardiovascular fitness and health in adults,3, 4, 5, 6 the most vulnerable group would be survivors of extremely preterm birth. Two previous studies of children7 and adolescents8 concluded that no or only minor cardiovascular effects were associated with extremely preterm birth.…”

“…To some extent, these discrepancies in findings may reflect contributions from perinatal risk factors and exposures besides preterm birth, such as fetal growth restriction and neonatal morbidity. In addition, participants in 2 of these studies4, 8 were born between 1985 and 1991, and thus their outcomes may reflect selected survival and another, older type of care than the one used in more contemporary neonatal medicine. Finally, the selection of control group or normative reference data is critical for interpretation.…”

Endothelial Colony‐Forming Cells in Young Adults Born Preterm: A Novel Link Between Neonatal Complications and Adult Risks for Cardiovascular Disease

“…We further investigated whether ECFC characteristics correlated with adult cardiovascular risk factors known to be associated with very preterm birth, in particular, blood pressure2, 24 and left ventricular mass index 6. Table 4 shows the relationship between ECFC function and daytime ABPM systolic blood pressure and left ventricular mass index in preterm and term groups.…”

“…Mounting evidence supports the adverse effect of preterm birth, and more so very preterm birth (<32 weeks gestational age), on cardiovascular health 1, 2. Individuals born preterm display both structural and functional cardiovascular alterations, which include higher blood pressure,2 microvasculature rarefaction,3, 4 increased vascular resistance,5 as well as changes in heart shape and function,6, 7, 8 which are independent harbingers of hypertension and cardiovascular disease 9, 10. Given that rates of preterm birth have increased along with improved survival, it is expected that the absolute number of adults born preterm, and therefore at risk of developing cardiovascular disease, will escalate in the future.…”