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

Abstract

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.

Postnatal Expression Profile of MicroRNAs Associated with Cardiovascular Diseases in 3- to 11-Year-Old Preterm-Born Children

“…The highest postnatal microRNA expression levels were observed in children born prematurely at lower gestational ages and in children born with lower birth weight. These findings may also contribute to the explanation of why preterm-born children with lower birth weight have an increased cardiovascular risk and to the explanation of the increase in cardiovascular risk with the decrease in gestational age at delivery [2,5,[9][10][11]15,19,20,22,23,26,27,29,31,35,39,43,44,51,58,59].…”

“…Moreover, children, adolescents, or young preterm-born adults were reported to have alterations in both left heart and right heart structure, geometry, and function and alterations in arterial structure and distensibility. Smaller left ventricles [9,12,50], smaller right atria [51], smaller right ventricles [51,52], greater right and left ventricular mass [50,52], smaller ascending aorta diameter [9,18], and higher relative wall thickness [51] were observed in children, adolescents, and young adults born preterm. In addition, narrower abdominal aortas and lower abdominal aortic stiffness were detected together with higher brachial and aortic blood pressures [24].…”

“…In addition, narrower abdominal aortas and lower abdominal aortic stiffness were detected together with higher brachial and aortic blood pressures [24]. Besides, lower left ventricular longitudinal shortening and systolic tissue velocity [12], higher transversal shortening fraction [12], lower atrial emptying velocities [12], higher right ventricular myocardial performance index (RVmpi') [51], elevated aortic wave reflection [14], decreased carotid and brachial distensibility [18], and higher estimated pulmonary vascular resistance (PVR) [51] were found in children, adolescents, and young preterm-born adults.…”

Insulin resistance parameters in children born very preterm and adequate for gestational age

“…In agreement with our findings, Mohlkert et al 23 reported that in 6‐year‐old children born extremely preterm, no signs of accelerated intima‐media thickening or arterial stiffening were found. However, the same author reported years later that children born extremely preterm exhibit higher estimated pulmonary vascular resistance and altered right heart structure and function compared with children born at term 24 . Other authors reported that at eleven years old, patients had increased cIMT and systolic BP.…”

Effect of Preterm Birth on Cardiac and Cardiomyocyte Growth and the Consequences of Antenatal and Postnatal Glucocorticoid Treatment

“…The increased blood pressure and increased cardiac mass in young adults born preterm likely arise consequent to events during the perinatal period: cardiac magnetic resonance imaging studies have shown clear evidence of cardiac changes first emerging early in life [62,63]. Preterm infants in the early postnatal period (soon after delivery to 3 months of age) have a disproportionate increase in ventricular mass to body and cardiac size [62,64], and increased intraventricular septal thickness [65] and altered right ventricular structure and function [66] are evident by early childhood. Interestingly, increased left ventricular myocardial wall thickness in preterm neonates was independently associated with the degree of prematurity, antenatal glucocorticoid administration, and requirement for postnatal respiratory support [63].…”