Multimodality Imaging Demonstrates Reduced Right-Ventricular Function Independent of Pulmonary Physiology in Moderately Preterm-Born Adults

Mohamed, Afifah; Lamata, Pablo; Williamson, Wilby; Alsharqi, Maryam; Tan, Cheryl; Burchert, Holger; Huckstep, O J; Suriano, Katie; Francis, Jane M; Pelado, Joana Leal; Monteiro, C; Neubauer, Stefan; Levy, Philip; Leeson, Paul; Lewandowski, Adam J.

doi:10.1016/j.jcmg.2020.03.016

Cited by 31 publications

(44 citation statements)

References 5 publications

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“…However, an early alteration of RV systolic function could not be ruled out with TAPSE being significantly lower in the EXPT group. This is consistent with findings recently reported in a multimodal RV study of moderately preterm born adults [ 33 ].…”

Section: Discussionsupporting

confidence: 93%

Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm—A Population-Based Cohort Study

Mohlkert

Hallberg

Broberg

et al. 2020

JCM

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Preterm birth has been associated with altered cardiac phenotype in adults. Our aim was to test the hypothesis that children surviving extremely preterm birth have important structural or functional changes of the right heart or pulmonary circulation. We also examined relations between birth size, gestational age, neonatal diagnoses of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) with cardiac outcomes. We assessed a population-based cohort of children born in Sweden before 27 weeks of gestation with echocardiography at 6.5 years of age (n = 176). Each preterm child was matched to a healthy control child born at term. Children born preterm had significantly smaller right atria, right ventricles with smaller widths, higher relative wall thickness and higher estimated pulmonary vascular resistance (PVR) than controls. In preterm children, PVR and right ventricular myocardial performance index (RVmpi’) were significantly higher in those with a PDA as neonates than in those without PDA, but no such associations were found with BPD. In conclusion, children born extremely preterm exhibit higher estimated PVR, altered right heart structure and function compared with children born at term.

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Section: Discussionsupporting

confidence: 93%

Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm—A Population-Based Cohort Study

Mohlkert

Hallberg

Broberg

et al. 2020

JCM

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“… 16 Using echocardiography, the study showed that preterm-born young adults had smaller LV end-diastolic volumes and dimensions and increased LV mass indexed to body size, as well as impaired longitudinal systolic strain. In the same cohort, body size indexed RV end-diastolic areas and volumes for echocardiography and CMR were lower in preterm-born individuals, 17 with RV CMR revealing higher RV mass, lower RV ejection fraction, and a unique 3-dimensional geometry by computational atlas formation in those born preterm. Measurements of RV function by echocardiography, including RV fractional area of change and tricuspid annular plane systolic excursion, were lower in preterm-born compared with term-born young adults, with RV changes remaining significant when adjusting for pulmonary function parameters by spirometry.…”

Section: Late Sequelae and Future Cardiovascular Disease Riskmentioning

confidence: 81%

“…Although the findings of reduced LV and RV volumes and dimensions are consistent across studies in adolescence and young adulthood, 14 – 20 differences in mass are less consistent. While some studies using both CMR 14 , 15 , 17 and echocardiography 16 – 18 have reported higher LV and RV mass in preterm-born young adults compared with term-born controls, others have reported lower mass in those born preterm. 19 – 21 A recent study using CMR in a group of 40 normotensive adolescents, of which 20 were born preterm with an average gestational age of 28 weeks, and 70 normotensive young adults, of which 38 were born preterm with an average gestational age of 29 weeks, showed that both LV and RV end-diastolic and stroke volumes were lower in the preterm groups, as was LV mass when indexed to body size.…”

Section: Late Sequelae and Future Cardiovascular Disease Riskmentioning

confidence: 99%

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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“…The end-diastolic and end-systolic cardiac phases and basal and apical LV slices were visually determined as previously described. 10,15 Average LV wall thickness was measured on the midventricular short-axis slice at end diastole. Relative wall thickness (RWT) was calculated on the midventricular short-axis slice at end diastole as the LV inferolateral plus anteroseptal wall thickness, all divided by LV cavity diameter.…”

Section: Image Analysismentioning

confidence: 99%

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

et al. 2021

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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.

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Multimodality Imaging Demonstrates Reduced Right-Ventricular Function Independent of Pulmonary Physiology in Moderately Preterm-Born Adults

Cited by 31 publications

References 5 publications

Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm—A Population-Based Cohort Study

Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm—A Population-Based Cohort Study

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

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

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