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Published on: January 27, 2023
Cardiac remodeling in preterm infants with prolonged exposure to a patent ductus arteriosus
Koert de Waal1, Nilkant Phad1, Nick Collins2
1Department of Neonatology, John Hunter Children's Hospital, University of Newcastle, Newcastle, NSW, Australia.
Insights
Patent ductus arteriosus (PDA) in preterm infants causes significant early left heart remodeling. However, this cardiac adaptation appears compensated, preserving systolic function and suggesting adaptive changes rather than pathology.
Area of Science:
- Neonatal cardiology
- Pediatric cardiovascular research
- Fetal and neonatal physiology
Background:
- Patent ductus arteriosus (PDA) causes sustained volume load, leading to cardiac remodeling.
- Cardiac remodeling can progress to pathological changes and cardiovascular disease.
- Limited data exists on cardiac remodeling in preterm infants with PDA.
Purpose of the Study:
- To investigate cardiac remodeling changes in preterm infants with PDA.
- To compare remodeling in infants with prolonged PDA exposure versus controls.
Main Methods:
- Collected clinical and echocardiography data from preterm infants (<30 weeks gestation).
- Utilized conventional and speckle tracking echocardiography for image analysis.
- Compared infants with prolonged PDA (>14 days) to a control group.
Main Results:
- Left heart remodeled to a larger, more spherical shape, increasing volume significantly.
- Cardiac changes peaked within 4 weeks, then normalized.
- Systolic function and filling pressures increased; arterial elastance decreased, while contractility remained unchanged.
Conclusions:
- Preterm PDA induces early and significant left heart remodeling.
- Compensated cardiac physiology with preserved systolic function suggests adaptive remodeling.
- Prolonged PDA exposure may lead to adaptive, rather than pathological, cardiac changes.
Background:
Sustained volume load due to a patent ductus arteriosus (PDA) leads to cardiac remodeling. Remodeling changes can become pathological and are associated with cardiovascular disease progression. Data on remodeling changes in preterm infants is not available.
Methods:
Clinical and echocardiography data were collected in preterm infants <30 weeks gestation on postnatal day 3 and then every 7-14 days until closure of the ductus arteriosus. Images were analyzed using conventional techniques and speckle tracking. Remodeling changes of infants with prolonged (>14 days) exposure to a PDA were compared to control infants without a PDA.
Results:
Thirty out of 189 infants had prolonged exposure to a PDA. The left heart remodeled to a larger and more spherical shape and thus significantly increased in volume. Most changes occurred in the first 4 weeks, plateaued, and then returned to control values. Systolic function and estimates of filling pressure increased and effective arterial elastance reduced with a PDA, however contractility was unchanged. Wall thickness increased after 4 weeks of increased volume exposure.
Conclusion:
The preterm PDA induces early and significant remodeling of the left heart. A compensated cardiac physiology was seen with preserved systolic function, suggesting adaptive rather than pathological remodeling changes with prolonged exposure to a PDA.
