Altered Right Ventricular Filling at Four-dimensional Flow MRI in Young Adults Born Prematurely

Corrado, Philip A; Barton, Gregory P.; Macdonald, Jacob A.; François, Christopher J.; Eldridge, Marlowe W.; Goss, Kara N.; Wieben, Oliver

doi:10.1148/ryct.2021200618

Cited by 4 publications

(2 citation statements)

References 47 publications

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“…This is a situation with similarities to patients with (borderline) pulmonary hypertension or a Fontan circulation, where reduced flow through the pulmonary circulation hampers LV preload, limiting exercise capacity (27)(28)(29). Another factor in reduced ventricular volume during exercise could be impaired RV preload and/or LV/RV diastolic function, hampering LV ventricular filling (30,31). This has not been studied for adults with BPD separately.…”

Section: Discussionmentioning

confidence: 99%

Cardiac dysfunction during exercise in young adults with bronchopulmonary dysplasia

Steenhorst,

Helbing,

van Genuchten

et al. 2024

ERJ Open Res

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BackgroundWorldwide, 1–2% of children is born premature and at risk for developing bronchopulmonary dysplasia (BPD). Preterm born adults are at risk for early cardiovascular disease. The role of BPD is unclear.AimThis study aims to examine cardiorespiratory function during submaximal exercise in young adult survivors of extreme prematurity, with or without BPD.MethodsForty premature born young adults, 20 with BPD (median[IQR] gestational age (GA), 27 [26–28] weeks) and 20 without BPD (GA age 28 [27–29] weeks) were prospectively compared to age-matched at term born (AT) adults (GA 39 [38–40] weeks). Participants underwent exercise testing and cardiovascular magnetic resonance (CMR) with submaximal exercise.ResultsResting heart rate in BPD subjects was higher than in AT born subjects (69±10versus61±7 mL, p=0.01). Peak oxygen uptake at maximal CPET was decreased in BPD patients (91±18versus106±17% of predicted, p=0.01). In BPD subjects cardiac stroke volume (SV) change with exercise was impaired compared to AT subjects (11±13%versus25±10%; p<0.001). With exercise, left ventricular end-diastolic volume decreased more in preterm borns withversuswithout BPD (−10±8%versus−3±8%; p=0.01) and compared to AT subjects (0±5%; p<0.001). Exploratory data analysis revealed that exercise SV and end-diastolic volume change were inversely correlated with oxygen dependency in those born prematurely.ConclusionsIn preterm born young adults –particularly those with BPD– resting cardiac function, exercise performance and cardiac response to exercise is impaired compared to controls. Exercise CMR may reveal an important predisposition for heart disease later in life.

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Section: Discussionmentioning

confidence: 99%

Cardiac dysfunction during exercise in young adults with bronchopulmonary dysplasia

Steenhorst,

Helbing,

van Genuchten

et al. 2024

ERJ Open Res

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show abstract

“…Young adult survivors of prematurity exhibit higher pulmonary arterial pressure (PAP), accompanied by a blunted exercise response, which is associated with cardiac remodelling (Corrado, Barton, Macdonald et al., 2021; Crispi et al., 2021; Goss et al., 2018). However, conflicting results have been published concerning the structural and functional cardiac phenotype in these patients.…”

Section: Introductionmentioning

confidence: 99%

Exercise and hypoxia unmask pulmonary vascular disease and right ventricular dysfunction in a 10‐ to 12‐week‐old swine model of neonatal oxidative injury

Steenhorst

Hirsch

Verzijl

et al. 2022

The Journal of Physiology

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Prematurely born young adults who experienced neonatal oxidative injury (NOI) of the lungs have increased incidence of cardiovascular disease. Here, we investigated the long‐term effects of NOI on cardiopulmonary function in piglets at the age of 10–12 weeks. To induce NOI, term‐born piglets (1.81 ± 0.06 kg) were exposed to hypoxia (10–12% FiO2${F}_{{\rm{iO}}_{\rm{2}}}$), within 2 days after birth, and maintained for 4 weeks or until symptoms of heart failure developed (range 16–28 days), while SHAM piglets were normoxia raised. Following recovery (>5 weeks), NOI piglets were surgically instrumented to measure haemodynamics during hypoxic challenge testing (HCT) and exercise with modulation of the nitric‐oxide system. During exercise, NOI piglets showed a normal increase in cardiac index, but an exaggerated increase in pulmonary artery pressure and a blunted increase in left atrial pressure – suggesting left atrial under‐filling – consistent with an elevated pulmonary vascular resistance (PVR), which correlated with the duration of hypoxia exposure. Moreover, hypoxia duration correlated inversely with stroke volume (SV) during exercise. Nitric oxide synthase inhibition and HCT resulted in an exaggerated increase in PVR, while the PVR reduction by phosphodiesterase‐5 inhibition was enhanced in NOI compared to SHAM piglets. Finally, within the NOI piglet group, prolonged duration of hypoxia was associated with a better maintenance of SV during HCT, likely due to the increase in RV mass. In conclusion, duration of neonatal hypoxia appears an important determinant of alterations in cardiopulmonary function that persist further into life. These changes encompass both pulmonary vascular and cardiac responses to hypoxia and exercise. Key points Children who suffered from neonatal oxidative injury, such as very preterm born infants, have increased risk of cardiopulmonary disease later in life. Risk stratification requires knowledge of the mechanistic underpinning and the time course of progression into cardiopulmonary disease. Exercise and hypoxic challenge testing showed that 10‐ to 12‐week‐old swine that previously experienced neonatal oxidative injury had increased pulmonary vascular resistance and nitric oxide dependency. Duration of neonatal oxidative injury was a determinant of structural and functional cardiopulmonary remodelling later in life. Remodelling of the right ventricle, as a result of prolonged neonatal oxidative injury, resulted in worse performance during exercise, but enabled better performance during the hypoxic challenge test. Increased nitric oxide dependency together with age‐ or comorbidity‐related endothelial dysfunction may contribute to predisposition to pulmonary hypertension later in life.

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Smaller Left Ventricular Size But Preserved Function in Adolescents and Adults Born Preterm

Barton,

Chandra,

Sanchez‐Solano

et al. 2024

JAHA

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Background Prematurely born adults have increased risk for cardiovascular disease. There are limited cardiac data on US‐born preterm individuals. We aimed to determine whether adolescents and adults born prematurely have altered left ventricular (LV) structure and function, and to interrogate diastolic function using isometric handgrip exercise. Methods and Results Adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 g birth weight) were recruited from the Parkland Health Neonatal Intensive Care Unit Registry. Full‐term participants were recruited from the local area. Study procedures included anthropometrics and vitals, handgrip testing, and echocardiography performed at rest and during isometric handgrip exercise. Data were reported as mean±SD. The study enrolled 107 preterm and 48 term participants. Preterm participants (gestational age: 29.5±2.5 weeks) were shorter with higher body mass index ( P <0.001) compared with term participants. Preterm participants exhibited smaller LV end‐diastolic volume index (50.8±10.1 versus 56.9±10.0 mL/m 2 , P <0.001), LV stroke volume index (29.6±6.0 versus 34.1±6.5 mL/m 2 , P <0.001), and LV mass index (67.2±13.1 versus 73.3±14.2 g/m 2 , P =0.002) compared with term individuals. Preterm participants also had subclinical reductions in LV peak systolic tissue velocity and peak early diastolic tissue velocity lateral at rest. Isometric handgrip exercise promoted a reduction in diastolic function and an increase in hemodynamic measures, but changes during isometric handgrip exercise were similar between groups. Conclusions Adolescents and adults born preterm exhibit overall normal cardiac function despite smaller cardiac volumes and mass compared with individuals born full term. Effects are most pronounced at the lowest gestational ages.

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Altered Right Ventricular Filling at Four-dimensional Flow MRI in Young Adults Born Prematurely

Cited by 4 publications

References 47 publications

Cardiac dysfunction during exercise in young adults with bronchopulmonary dysplasia

Cardiac dysfunction during exercise in young adults with bronchopulmonary dysplasia

Exercise and hypoxia unmask pulmonary vascular disease and right ventricular dysfunction in a 10‐ to 12‐week‐old swine model of neonatal oxidative injury

Smaller Left Ventricular Size But Preserved Function in Adolescents and Adults Born Preterm

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