Physiological Stress Elicits Impaired Left Ventricular Function in Preterm-Born Adults

Abstract

BackgroundExperimental and clinical studies show that prematurity leads to altered left ventricular (LV) structure and function with preserved resting LV ejection fraction (EF). Large-scale epidemiological data now links prematurity to increased early heart failure risk.ObjectivesThe authors performed echocardiographic imaging at prescribed exercise intensities to determine whether preterm-born adults have impaired LV functional response to physical exercise.MethodsWe recruited 101 normotensive young adults born preterm (n = 47; mean gestational age 32.8 ± 3.2 weeks) and term (n = 54) for detailed cardiovascular phenotyping. Full clinical resting and exercise stress echocardiograms were performed, with apical 4-chamber views collected while exercising at 40%, 60%, and 80% of peak exercise capacity, determined by maximal cardiopulmonary exercise testing.ResultsPreterm-born individuals had greater LV mass (p = 0.015) with lower peak systolic longitudinal strain (p = 0.038) and similar EF to term-born control subjects at rest (p = 0.62). However, by 60% exercise intensity, EF was 6.7% lower in preterm subjects (71.9 ± 8.7% vs 78.6 ± 5.4%; p = 0.004) and further declined to 7.3% below the term-born group at 80% exercise intensity (69.8 ± 6.4% vs 77.1 ± 6.3%; p = 0.004). Submaximal cardiac output reserve was 56% lower in preterm-born subjects versus term-born control subjects at 40% of peak exercise capacity (729 ± 1,162 ml/min/m2 vs. 1,669 ± 937 ml/min/m2; p = 0.021). LV length and resting peak systolic longitudinal strain predicted EF increase from rest to 60% exercise intensity in the preterm group (r = 0.68, p = 0.009 and r = 0.56, p = 0.031, respectively).ConclusionsPreterm-born young adults had impaired LV response to physiological stress when subjected to physical exercise, which suggested a reduced myocardial functional reserve that might help explain their increased risk of early heart failure. (Young Adult Cardiovascular Health sTudy [YACHT]; NCT02103231)

The Transitional Heart: From Early Embryonic and Fetal Development to Neonatal Life

“…Studies using echocardiography and MRI have highlighted the early impact on long-term cardiovascular development associated with prematurity, with potentially adverse remodeling in infants, children, adolescents, and young adults [10,112,[135][136][137]. In addition to the unique geometric and functional cardiac changes at rest, the pre-Fetal Diagn Ther 2020;47:373-386 DOI: 10.1159/000501906 term cardiac phenotype is also characterized by a reduced myocardial functional reserve [138], which together may explain their increased risk of heart failure as early as childhood and into young adulthood [34,[139][140][141].…”

Like sheep, like humans? Right ventricular remodelling in a preterm‐born ovine model

“…), and is characterized by an impaired myocardial functional reserve in young adulthood under physiological stress (Huckstep et al . ). There is thus a need for experimental and human studies investigating the underlying mechanisms leading to preterm cardiac alterations.…”

Postexercise Heart Rate Recovery in Adults Born Preterm

“…[1][2][3][4][5][6] Studies report on elevated blood pressure, greater blood pressure variability, and altered autonomic control. [7][8][9] Recent literature has connected preterm birth to increased risk of early heart failure, 32 reduced myocardial functional reserve during exercise, 33,34 and to ventricular structural differences in adulthood. 35,36 Birth at VLBW or at extremely low birth weight has been associated with impaired glucose regulation and obstructive airflow.…”