Comprehensive multi-modality assessment of regional and global arterial structure and function in adults born preterm

Abstract

Preterm birth is associated with higher blood pressure, which could be because preterm birth alters early aortic elastin and collagen development to cause increased arterial stiffness. We measured central and conduit artery size and multiple indices of arterial stiffness to define the extent and severity of macrovascular changes in individuals born preterm. A total of 102 young adults born preterm and 102 controls who were born after an uncomplicated pregnancy underwent cardiovascular magnetic resonance on a Siemens 1.5 T scanner to measure the aortic cross-sectional area in multiple locations. Ultrasound imaging with a Philips CX50 and linear array probe was used to measure carotid and brachial artery diameters. Carotid-femoral pulse wave velocity and the augmentation index were measured by SphygmoCor, brachial-femoral pulse wave velocity by Vicorder and aortic pulse wave velocity by cardiovascular magnetic resonance. The cardio-ankle vascular index (CAVI) was used as a measurement of global stiffness, and ultrasound was used to assess peripheral vessel distensibility. Adults born preterm had 20% smaller thoracic and abdominal aortic lumens (2.19±0.44 vs. 2.69±0.60 cm2, P<0.001; 1.25±0.36 vs. 1.94±0.45 cm2, P<0.001, respectively) but similar carotid and brachial diameters to adults born at term. Pulse wave velocity was increased (5.82±0.80 vs. 5.47±0.59 m s−1, P<0.01, 9.06±1.25 vs. 8.33±1.28 m s−1, P=0.01, 5.23±1.19 vs. 4.75±0.91 m s−1, P<0.01) and carotid distensibility was decreased (4.75±1.31 vs. 5.60±1.48 mm Hg−1103, P<0.001) in this group compared with the group born at term. However, the global and peripheral arterial stiffness measured by CAVI and brachial ultrasound did not differ (5.95±0.72 vs. 5.98±0.60, P=0.80 and 1.07±0.48 vs. 1.19±0.54 mm Hg−1103, P=0.12, respectively). Adults who are born preterm have significant differences in their aortic structure from adults born at term, but they have relatively small differences in central arterial stiffness that may be partially explained by blood pressure variations.

Preterm arteries in childhood: dimensions, intima-media thickness, and elasticity of the aorta, coronaries, and carotids in 6-y-old children born extremely preterm

“…previously demonstrated that both the aorta and the carotid arteries suffered from grow failure in the first 6 mo after very preterm birth (12) the aorta appears to be more sensitive to long-lasting growth retardation than the carotid arteries (14,20,32). These interpretations are supported by recent data demonstrating aortic narrowing in young adults born very preterm, but similar carotid and brachial artery size as in adults born at term (33). The study of coronary arteries in children born extremely preterm is an unexplored field.…”

Adults born preterm: a review of general health and system-specific outcomes

“…Abnormal growth of the vascular tree and persisting endothelial malfunction following preterm birth and/or low birthweight could be the pathogenesis for higher blood pressure in adults born preterm . A series of studies from a single group of investigators has reported abnormalities in different components of the vascular architecture, and in the shape and contractive functions of heart chambers in children, adolescents and young adults born preterm . A German cohort study reported significant abnormalities in carotid artery thickness and microvascular density in children (mean age 11.8 years) born extremely preterm .…”

Preterm Birth Is a Novel, Independent Risk Factor for Altered Cardiac Remodeling and Early Heart Failure: Is it Time for a New Cardiomyopathy?

“…Of mechanistic interest was the finding that increased systolic blood pressure in preterm-born young adults is associated with an enhanced antiangiogenic state in adulthood that seems to be mediated through capillary rarefaction and is independent of other cardiovascular changes [16]. Increases in arterial stiffness have also repeatedly been reported at different stages of development, which may contribute to their increased risk of cardiovascular events in the long term [17][18][19][20].…”