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Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults
Kara N Goss1,2, Kristin Haraldsdottir1,3, Arij G Beshish1
1Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.
Insights
Premature birth is linked to smaller heart sizes and lower cardiac mass in adolescents and young adults. These structural changes may increase lifelong cardiovascular disease risk, even with preserved heart function.
Area of Science:
- Cardiology
- Neonatology
- Developmental Biology
Background:
- Premature birth significantly elevates lifetime risk for cardiovascular diseases like arrhythmia, ischemic disease, and heart failure.
- The underlying biological mechanisms connecting premature birth to long-term cardiac health remain incompletely understood.
Purpose of the Study:
- To investigate cardiac structure and function in adolescents and young adults born preterm.
- Utilize cardiac magnetic resonance imaging (MRI) to characterize cardiac morphology and function.
Main Methods:
- Cross-sectional cohort study involving adolescents and young adults born moderately to extremely premature.
- Comparison with age-matched participants born at term, all undergoing cardiac MRI.
- Analysis focused on biventricular volume, mass, and strain measurements.
Main Results:
- Individuals born preterm exhibited statistically significant reductions in biventricular cardiac chamber size and mass compared to term-born peers.
- Left ventricular end-diastolic and end-systolic volume indices were significantly smaller in preterm groups.
- While biventricular ejection fractions were preserved, stroke volume index was reduced; adults born preterm showed a hypercontractile right ventricle.
Conclusions:
- Adolescents and young adults born prematurely display smaller cardiac chambers and reduced cardiac mass.
- These morphological differences, despite preserved function, may underlie the increased lifetime cardiovascular disease risk associated with premature birth.
Importance:
Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood.
Objective:
To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI).
Design, Setting, And Participants:
This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019.
Exposures:
Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g.
Main Outcomes And Measures:
Main study outcomes included MRI measures of biventricular volume, mass, and strain.
Results:
Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely.
Conclusions And Relevance:
In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.
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