Reduced Right Ventricular Size and Function in Adolescents and Adults Born Preterm

Adults born premature have smaller cardiac chamber sizes, and some develop right ventricular (RV) dysfunction. Risk factors for RV dysfunction into adulthood remain unclear. The aim of this study was to investigate right-sided cardiac structure and function among adolescents and adults born preterm.

Participants born moderately to extremely premature (≤32 weeks) or at very low birth weight (<1500 g) aged 12 to 40 years were recruited from the Parkland Health Neonatal Intensive Care Unit Registry. Healthy term-born similarly aged participants were recruited from Dallas County. Study visits included anthropometric measurements, a cardiopulmonary examination, and echocardiography. Multivariable linear regression models were used to determine the main effect of prematurity (yes or no) and gestational age on right atrial and RV structure and function after adjusting for age, sex, body surface area, and birth weight Z scores.

Preterm participants (n = 107) had a mean gestational age of 29.3 ± 2.7 weeks and a mean birth weight of 1,320 ± 398 g. Compared with term participants (n = 48), echocardiography demonstrated smaller right atrial volume and RV area. Tricuspid annular plane systolic excursion, tissue Doppler imaging systolic tricuspid annular peak velocity (RV s'), and early diastolic velocity (RV e') were lower in preterm participants, with a significant dose response with gestational age and in the absence of overt pulmonary hypertension.

Right-sided chamber sizes were smaller, with reduced tricuspid annular plane systolic excursion, RV s', and RV e' in adolescents and adults born premature, with a clear association with gestational age. Reduced RV function in the absence of overt pulmonary hypertension suggests preterm birth imparts an independent insult on the developing RV with lifetime implications.