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Exercise-induced irregular right heart flow dynamics in adolescents and young adults born preterm
Jacob A Macdonald1, Grant S Roberts2, Philip A Corrado2
1Radiology, Duke University, Durham, USA. jacob.macdonald@duke.edu.
Insights
Preterm birth impacts adolescent and young adult heart function, showing reduced cardiac output during exercise and altered right ventricle blood flow dynamics. These changes suggest a potential increased risk for future cardiopulmonary disease.
Area of Science:
- Cardiovascular Physiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Preterm birth is associated with increased long-term risk of heart failure and cardiopulmonary disease.
- Improved neonatal care has led to a higher survival rate for preterm infants, with many now reaching adulthood.
- Understanding the long-term cardiovascular effects of preterm birth is crucial for preventative care.
Purpose of the Study:
- To assess the impact of preterm birth on right heart flow dynamics in adolescents and young adults.
- To investigate cardiovascular function during exercise in individuals born preterm compared to those born at term.
- To identify early signs of potential cardiovascular abnormalities related to preterm birth.
Main Methods:
- Utilized 4D flow cardiovascular magnetic resonance (CMR) imaging.
- Assessed right heart flow dynamics, including stroke volume and cardiac output, at rest and during exercise.
- Quantified kinetic energy and vorticity in the right ventricle during diastole.
Main Results:
- Individuals born preterm exhibited a decreased stroke volume response to exercise compared to term-born controls.
- The preterm group showed a significantly lower increase in cardiac output during exercise stress.
- Elevated kinetic energy and vorticity in the right ventricle during diastole suggest altered diastolic flow dynamics in preterm-born subjects.
Conclusions:
- Preterm birth is linked to altered right-heart flow dynamics, observable as early as adolescence, particularly during diastole.
- These findings indicate potential long-term cardiovascular implications for individuals born preterm.
- Further research is warranted to determine if these altered dynamics contribute to the development of cardiopulmonary disease later in life.
Background:
Preterm birth has been linked to an elevated risk of heart failure and cardiopulmonary disease later in life. With improved neonatal care and survival, most infants born preterm are now reaching adulthood. In this study, we used 4D flow cardiovascular magnetic resonance (CMR) coupled with an exercise challenge to assess the impact of preterm birth on right heart flow dynamics in otherwise healthy adolescents and young adults who were born preterm.
Methods:
Eleven young adults and 17 adolescents born preterm (< 32 weeks of gestation and < 1500 g birth weight) were compared to 11 young adult and 18 adolescent age-matched controls born at term. Stroke volume, cardiac output, and flow in the main pulmonary artery were quantified with 4D flow CMR. Kinetic energy and vorticity were measured in the right ventricle. All parameters were measured at rest and during exercise at a power corresponding to 70% VO2max for each subject. Multivariate linear regression was used to perform age-adjusted term-preterm comparisons.
Results:
With exercise, stroke volume increased 10 ± 21% in term controls and decreased 4 ± 18% in preterm born subjects (p = 0.007). This resulted in significantly reduced capacity to increase cardiac output in response to exercise stress for the preterm group (58 ± 26% increase in controls, 36 ± 27% increase in preterm, p = 0.004). Elevated kinetic energy (KEterm = 71 ± 22 nJ, KEpreterm = 87 ± 38 nJ, p = 0.03) and vorticity (ωterm = 79 ± 16 s-1, ωpreterm = 94 ± 32 s-1, p = 0.01) during diastole in the right ventricle (RV) suggested altered RV flow dynamics in the preterm subjects. Streamline visualizations showed altered structure to the diastolic filling vortices in those born preterm.
Conclusions:
For the participants examined here, preterm birth appeared to result in altered right-heart flow dynamics as early as adolescence, especially during diastole. Future studies should evaluate whether the altered dynamics identified here evolves into cardiopulmonary disease later in life. Trial registration None.
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