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Subclinical Changes in Left Heart Structure and Function at Preschool Age in Very Low Birth Weight Preterm Infants
Hung-Yang Chang1,2, Jui-Hsing Chang1,2, Chun-Chih Peng1,2
1Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
Insights
Preterm birth survivors with very low birth weight show subclinical left heart changes by preschool age. These findings highlight the need for long-term cardiovascular monitoring in this high-risk group.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Neonatology
Background:
- Preterm birth survivors face increased risks of long-term cardiovascular issues.
- Very low birth weight (VLBW) preterm infants represent a particularly vulnerable population for cardiovascular sequelae.
Purpose of the Study:
- To evaluate left heart structure and function in preschool-aged children born preterm with VLBW.
- To identify potential subclinical cardiovascular changes in this cohort.
Main Methods:
- Prospective observational study comparing VLBW preterm children (n=87) with term-born controls (n=29).
- Utilized conventional and speckle-tracking echocardiography to assess cardiac parameters.
- Analyzed left ventricular (LV) and left atrial (LA) dimensions, volumes, and strain parameters.
Main Results:
- VLBW preterm children exhibited significantly smaller LV and LA dimensions and volumes compared to term controls.
- Reduced LV global longitudinal strain and systolic strain rate were observed in the preterm group.
- Decreased LA longitudinal strain and increased LA stiffness index were noted in VLBW preterm survivors, though all measurements remained within normal ranges.
Conclusions:
- Subclinical alterations in left heart structure and function are detectable in VLBW preterm infants by preschool age.
- Long-term cardiovascular outcome monitoring is crucial for this vulnerable population.
- Early identification of cardiac changes may inform future preventative strategies.
Background:
Survivors of preterm birth are at risk of long-term cardiovascular consequences. The objective of this prospective observational study was to assess left heart function at preschool age in preterm children with very low birth weight (VLBW).
Methods:
We recruited children aged 5-6 years from preterm infants and full-term children. All subjects underwent conventional echocardiography and speckle-tracking echocardiography. The results were compared between the preterm and term groups.
Results:
Eighty-seven VLBW preterm children and 29 term controls were included in the study. After adjusting for body surface area, the preterm group compared to the full-term group had significantly smaller left ventricular (LV) end-diastolic and end-systolic internal dimensions (31.2 vs. 33.5 mm, p = 0.048; and 20.0 vs. 21.6 mm, respectively; p = 0.024), lower LV end-diastolic and end-systolic volumes (38.8 vs. 46.3 mL, p = 0.024; and 12.8 vs. 15.6 mL, respectively; p = 0.008). Left atrial (LA) maximal and minimal volume were also significantly smaller in the preterm group (15.4 vs. 18.9 mL, p = 0.017; and 6.2 vs 7.5 mL, respectively; p = 0.018). LV global longitudinal strain (-21.4 vs. -23.2%, p < 0.0001) and systolic strain rate (-1.30 vs. -1.37 /s, p = 0.001) were significantly lower in the preterm group than in the term control group. LA longitudinal strain was decreased (43.9 vs. 52.8%, p < 0.0001) and left atrial stiffness index (0.17 vs. 0.14, p < 0.0001) was increased in preterm infants. However, all the measurements in both groups were within normal range.
Conclusions:
Subclinical changes of left heart structure and function were found in VLBW infants at preschool age. Additional long-term follow-ups of the cardiovascular outcomes are needed in this vulnerable population.
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