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

Abstract

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.

Evaluation of Changes in the Cardiac Function before and after Transcatheter Edge-to-Edge Mitral Valve Repair in Healthy Dogs: Conventional and Novel Echocardiography

“…The functional MR velocity indicates the pressure difference between LA and LV in the systole. The elevation of MR velocity after the procedure illustrates that the LV pressure in the systole was elevated, which is correlated with the elevation of FS and GRS [ 29 , 30 ].…”

Acute and chronic cardiac adaptations in adults born preterm

“…Given that preterm‐born adults are at an increased risk of developing hypertension and are more likely to have greater blood pressure levels than their term‐born peers as early as childhood (Lewandowski et al., 2020), our group has investigated what effect this may have on the observed changes in the LV of young adults born preterm. In a cohort of 468 individuals with CMR imaging, of which 200 were born preterm, it was shown that there was a significant, positive association in both preterm‐ and term‐born young adults between systolic blood pressure and LV mass (Mohamed et al., 2021). In addition to a leftward shift in the regression lines in those born preterm compared to those born at term, there was a stronger association between systolic blood pressure and LV mass in the preterm‐born compared to term‐born young adults.…”

Understanding the preterm human heart: What do we know so far?

“…The effect of prematurity on structural and functional cardiac parameters from birth until young adulthood was summarized by a recent meta‐analysis (Telles et al, 2020). Overall, the cardiac effects of premature birth manifest themselves across the spectrum of developmental stages and include smaller ventricular internal dimensions and impaired systolic and diastolic function (Figure 1) (Flahault et al, 2021; Goss et al, 2020; Huckstep et al, 2018; Kowalski et al, 2016; Lewandowski et al, 2021; Lewandowski, Augustine, et al, 2013; Lewandowski, Bradlow, et al, 2013; Mohamed et al, 2020, 2021; Mohlkert et al, 2018, 2020; Telles et al, 2020). Adults born preterm have since been shown to have greater myocardial diffuse fibrosis, characterized by excessive extracellular volume fraction by CMR, compared to their term‐born counterparts (Lewandowski et al, 2021).…”

“…In addition, cardiovascular risk factors later in life may further impact the geometry and function of the preterm heart. For instance, in a recent CMR imaging study of 468 young adults, of which 200 were preterm‐born, the extent to which blood pressure elevation affected LV remodeling was explored (Mohamed et al, 2021). It was shown that the unique structure and function of the preterm left ventricle was more susceptible to systolic blood pressure elevation.…”