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Retinal and Renal Microvasculature in Relation to Central Hemodynamics in 11-Year-Old Children Born Preterm or At
Fang-Fei Wei1,2,3, Anke Raaijmakers4, Jesus D Melgarejo1
1Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium.
Insights
Children born prematurely have higher blood pressure and altered pulse wave amplitudes, indicating vascular dysfunction. This study reveals a connection between microvascular and macrovascular health in these children.
Area of Science:
- Cardiovascular Research
- Pediatric Vascular Health
- Neonatal Medicine
Background:
- Prematurity impairs the development of blood vessels, increasing long-term vascular dysfunction risk.
- Previous research has not explored the interaction between microvasculature and macrovasculature in children.
- This study addresses the gap in understanding perinatal influences on childhood vascular health.
Purpose of the Study:
- To investigate the relationship between microvascular and macrovascular function in children born prematurely.
- To assess central blood pressure, pulse wave dynamics, and microvascular parameters in preterm-born children compared to controls.
- To identify potential crosstalk between different vascular systems in childhood.
Main Methods:
- A case-control study involving 55 children born weighing <1000g and 71 matched controls at age 11.
- Central blood pressure wave analysis using applanation tonometry and a wave separation algorithm.
- Measurement of renal resistive index and central retinal arteriolar equivalent.
Main Results:
- Preterm children exhibited higher central systolic blood pressure and backward wave amplitude compared to controls.
- Preterm children had a smaller central retinal arteriolar equivalent, indicating microvascular changes.
- Central retinal arteriolar equivalent was inversely associated with central systolic blood pressure and pulse wave amplitudes.
Conclusions:
- Prematurity is linked to elevated central blood pressure and altered pulse wave dynamics in childhood.
- The findings suggest a crosstalk between microcirculation and macrocirculation in preterm-born children.
- Higher renal resistive index may influence vascular wave reflections, impacting central hemodynamics.
Abstract:
Background Prematurity disrupts the perinatal maturation of the microvasculature and macrovasculature and confers high risk of vascular dysfunction later in life. No previous studies have investigated the crosstalk between the microvasculature and macrovasculature in childhood. Methods and Results In a case-control study, we enrolled 55 children aged 11 years weighing <1000 g at birth and 71 matched controls (October 2014-November 2015). We derived central blood pressure (BP) wave by applanation tonometry and calculated the forward/backward pulse waves by an automated pressure-based wave separation algorithm. We measured the renal resistive index by pulsed wave Doppler and the central retinal arteriolar equivalent by computer-assisted program software. Compared with controls, patients had higher central systolic BP (101.5 versus 95.2 mm Hg, P<0.001) and backward wave amplitude (15.5 versus 14.2 mm Hg, P=0.029), and smaller central retinal arteriolar equivalent (163.2 versus 175.4 µm, P<0.001). In multivariable analyses, central retinal arteriolar equivalent was smaller with higher values (+1 SD) of central systolic BP (-2.94 µm; 95% CI, -5.18 to -0.70 µm [P=0.011]) and forward (-2.57 µm; CI, -4.81 to -0.32 µm [P=0.026]) and backward (-3.20 µm; CI, -5.47 to -0.94 µm [P=0.006]) wave amplitudes. Greater renal resistive index was associated with higher backward wave amplitude (0.92 mm Hg, P=0.036). Conclusions In childhood, prematurity compared with term birth is associated with higher central systolic BP and forward/backward wave amplitudes. Higher renal resistive index likely moves reflection points closer to the heart, thereby explaining the inverse association of central retinal arteriolar equivalent with central systolic BP and backward wave amplitude. These observations highlight the crosstalk between the microcirculation and macrocirculation in children. Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT02147457.
