Impaired Right Ventricular–Vascular Coupling in Young Adults Born Preterm

Mulchrone, Ashley; Bellofiore, Alessandro; Douwes, Johannes M.; Duong, Neal; Beshish, Arij G.; Barton, Gregory P.; François, Christopher J.; Eldridge, Marlowe W.; Goss, Kara N.; Chesler, Naomi C.

doi:10.1164/rccm.201904-0767le

Cited by 24 publications

(30 citation statements)

References 7 publications

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“… 25 Among these subjects, RV-pulmonary vascular coupling was impaired in preterm-born relative to term-born subjects. 62 In contrast, an echocardiography-based study of ventriculo-vascular coupling in young adults born preterm with an average gestational age of 33 weeks demonstrated preserved RV coupling relative to term-born adults. 16 The lower gestational age in the catheter-based study further suggests that early RV-pulmonary artery uncoupling may be gestational age dependent.…”

Section: Late Sequelae and Future Cardiovascular Disease Riskmentioning

confidence: 87%

Impact of the Vulnerable Preterm Heart and Circulation on Adult Cardiovascular Disease Risk

et al. 2020

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Preterm birth accounts for over 15 million global births per year. Perinatal interventions introduced since the early 1980s, such as antenatal glucocorticoids, surfactant, and invasive ventilation strategies, have dramatically improved survival of even the smallest, most vulnerable neonates. As a result, a new generation of preterm-born individuals has now reached early adulthood, and they are at increased risk of cardiovascular diseases. To better understand the sequelae of preterm birth, cardiovascular follow-up studies in adolescents and young adults born preterm have focused on characterizing changes in cardiac, vascular, and pulmonary structure and function. Being born preterm associates with a reduced cardiac reserve and smaller left and right ventricular volumes, as well as decreased vascularity, increased vascular stiffness, and higher pressure of both the pulmonary and systemic vasculature. The purpose of this review is to present major epidemiological evidence linking preterm birth with cardiovascular disease; to discuss findings from clinical studies showing a long-term impact of preterm birth on cardiac remodeling, as well as the systemic and pulmonary vascular systems; to discuss differences across gestational ages; and to consider possible driving mechanisms and therapeutic approaches for reducing cardiovascular burden in individuals born preterm.

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Section: Late Sequelae and Future Cardiovascular Disease Riskmentioning

confidence: 87%

Impact of the Vulnerable Preterm Heart and Circulation on Adult Cardiovascular Disease Risk

et al. 2020

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“…Among adults previously recruited from the Newborn Lung Project, mean PA pressures were higher both at rest and during hypoxia, though there did not appear to be a greater hypoxic pulmonary vasoconstrictor response in those preterm [ 12 ]. Given that we identified early RV-pulmonary vascular uncoupling in a prior study, [ 13 ] we hypothesized that further hypoxic pulmonary vasoconstriction would worsen the RV functional response to hypoxia, and this attenuated RV response to hypoxia would be further exacerbated by a history of BPD.…”

Section: Discussionmentioning

confidence: 99%

“…Both adolescents and adults born preterm have a reduced ability to augment stroke volume during exercise, leading to reduced exercise tolerance overall [ 10 , 11 ]. Some studies suggest this may be exaggerated by early right ventricular–pulmonary vascular uncoupling due to underlying preclinical pulmonary hypertension in adults born preterm [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Exaggerated Cardiac Contractile Response to Hypoxia in Adults Born Preterm

Barton

Corrado

François

et al. 2021

JCM

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Individuals born prematurely have smaller hearts, cardiac limitations to exercise, and increased overall cardiometabolic risk. The cardiac effects of acute hypoxia exposure as another physiologic stressor remain under explored. The purpose of this study was to determine the effects of hypoxia on ventricular function in adults born preterm. Adults born moderately to extremely preterm (≤32 weeks gestation or <1500 g, N = 32) and born at term (N = 18) underwent cardiac magnetic resonance imaging under normoxic (21% O2) and hypoxic (12% O2) conditions to assess cardiovascular function. In normoxia, cardiac function parameters were similar between groups. During hypoxia, the right ventricular (RV) contractile response was significantly greater in participants born premature, demonstrated by greater increases in RV ejection fraction (EF) (p = 0.002), ventricular-vascular coupling (VVC) (p = 0.004), and strain (p < 0.0001) measures compared to term-born participants, respectively. Left ventricular contractile reserve was similar to term-born participants. Adults born preterm exhibit an exaggerated contractile response to acute hypoxia, particularly in the RV. This suggests that adults born preterm may have contractile reserve, despite the lack of volume reserve identified in previous exercise studies. However, this exaggerated and hyper-adapted response may also increase their risk for late RV failure.

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“…A newly introduced automated method relying on the second derivative of dP/dt decreases the variability of the measurement, but underestimates Pmax by an average of 13% [15]. Such an underestimation is necessarily associated with an overestimation of ESP and may therefore result in an underestimation of Ees/Ea [16,17]. HEERDT et al also on the second derivative of dP/dt but with a refined distribution function (the so-called "4 parameter Weibull peak fit") replacing more conventional sinusoid function.…”

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confidence: 99%