Acute and chronic cardiac adaptations in adults born preterm

Abstract

New Findings What is the topic of this review?Studies using cardiovascular magnetic resonance imaging and echocardiography to investigate cardiac alterations at rest and during exercise‐induced physiological stress in adults born preterm. What advances does it highlight?People born preterm have a greater long‐term cardiovascular risk, which may be explained in part by their cardiac structural and functional alterations. They have potentially adverse alterations in left and right ventricular structure and function that worsens with blood pressure elevation; an impaired myocardial functional reserve; and an increase in diffuse myocardial fibrosis that may drive their lower diastolic function. Abstract Preterm birth accounts for more than 10% of births worldwide and associates with a long‐term increase in cardiovascular disease risk. The period around preterm birth is a rapid and critical phase of cardiovascular development, which might explain why changes in multiple components of the cardiovascular system have been observed in individuals born preterm. These alterations include reduced microvascular density, increased macrovascular stiffness, and higher systolic and diastolic blood pressure. Cardiac alterations have been observed in people born preterm as early as neonatal life and infancy, with potentially adverse changes in both left and right ventricular structure and function extending into adulthood. Indeed, studies using cardiovascular magnetic resonance imaging and echocardiography have demonstrated that preterm‐born individuals have structural cardiac changes and functional impairments. Furthermore, myocardial tissue characterization by cardiovascular magnetic resonance imaging has demonstrated an increase in left ventricular diffuse myocardial fibrosis in young adults born preterm, and under acute physiological stress, their myocardial functional reserve assessed by echocardiography is reduced. The preterm heart is also more susceptible to chronic systolic blood pressure elevation, with a significantly greater increase in left ventricular mass as systolic blood pressure rises observed in preterm‐born compared to term‐born young adults. Given these known, potentially adverse acute and chronic cardiac adaptations in the preterm‐born population, primary prevention strategies are needed to reduce long‐term cardiovascular disease risk in this subgroup of the population.

A new cardiovascular disease risk factor for young adults: Preterm birth

“…Experimental animal and human preterm birth studies have found evidence of cardiac remodeling that result in increased biventricular mass, smaller ventricular cavities and volumes, and altered cardiac shape (more spherical than elliptical; Tan & Lewandowski, 2020). These anatomical remodeling changes influence ventricular function, causing lower ejection fraction, stroke volume, and cardiac output (Lewandowski, 2022). These changes have also been found to persist beyond childhood, predisposing those born prematurely to an increased risk of CVD conditions like hypertension, heart failure, and coronary artery disease as young adults (Crump, et al, 2021;Crump, 2020;Lewandowski, 2022).…”

“…These anatomical remodeling changes influence ventricular function, causing lower ejection fraction, stroke volume, and cardiac output (Lewandowski, 2022). These changes have also been found to persist beyond childhood, predisposing those born prematurely to an increased risk of CVD conditions like hypertension, heart failure, and coronary artery disease as young adults (Crump, et al, 2021;Crump, 2020;Lewandowski, 2022).…”

Physiological resilience across the lifecourse: in utero and beyond

“…Christopher Stewart and colleagues discuss the wonders of the human gut microbiome and its role in regulating physiology throughout the lifecourse (Ahearn-Ford et al, 2022). The post-natal period up to 3 years of age is especially important in setting the parameters of homeostasis and maturation as microbes colonize the human Adam Lewandowski also considers the impact of PTB on physiological outcomes later in life (Lewandowski, 2022). PTB, as mentioned above, is a risk factor for later development of cardiovascular disease.…”

“…These intricate studies provide valuable information as to the possible mechanisms contributing to the increased cardiac disease risk of being born prematurely. Of interest is a cross‐over of potential benefits remarked upon in the reviews of Lewandowski (2022) and Ahearn‐Ford et al. (2022) – for cardiac performance or gut microbiome homeostasis respectively – of continuous breast‐feeding of preterm infants.…”

“…Adam Lewandowski also considers the impact of PTB on physiological outcomes later in life (Lewandowski, 2022). PTB, as mentioned above, is a risk factor for later development of cardiovascular disease.…”