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LV Mass in Children With Extremely Low Birth Weight Is Lower But More Sensitive to Increased Blood Pressure
Art Schuermans1,2, Fang-Fei Wei3, Wen-Yi Yang4
1Biomedical Sciences Group, Faculty of Medicine (A.S., J.A.S.), KU Leuven, Belgium.
Insights
Children born extremely low birth weight (ELBW) have lower left ventricular mass. However, elevated blood pressure increases LV mass more in ELBW children, questioning current hypertension guidelines.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Cardiovascular Research
Background:
- Epidemiological data indicate increased heart failure risk in adults with extremely low birth weight (ELBW).
- Echocardiographic data in ELBW populations are inconsistent and often overlook modifiable factors like blood pressure.
- Understanding the cardiac phenotype in ELBW individuals is crucial for long-term health outcomes.
Purpose of the Study:
- To investigate the echocardiographic findings, specifically left ventricular (LV) mass, in children born ELBW compared to term-born controls.
- To assess the influence of modifiable factors, such as systolic blood pressure, on LV mass in ELBW children.
- To evaluate the cardiovascular outcomes and identify potential disparities in ELBW individuals.
Main Methods:
- Prospective case-control study (PREMATCH) including children born ELBW and term-born controls.
- Echocardiography was used to measure left ventricular (LV) mass as the primary outcome.
- Multivariable-adjusted regression models incorporated anthropometric variables and systolic blood pressure.
Main Results:
- Children born ELBW exhibited significantly lower LV mass compared to controls (adjusted difference: -8.49 g, P=0.002).
- A significant interaction between ELBW status and systolic blood pressure on LV mass was observed (P_interaction=0.039).
- The difference in LV mass between normotensive ELBW children and controls persisted, but disappeared in those with elevated blood pressure.
Conclusions:
- Children born ELBW demonstrate reduced LV mass during childhood.
- Elevated systolic blood pressure is associated with a disproportionately greater increase in LV mass in ELBW children.
- Current hypertension and LV hypertrophy diagnostic cutoffs for the general population may be inadequate for ELBW children.
Background:
Epidemiological evidence suggests higher rates of heart failure in adults born at an extremely low birth weight (ELBW). Reports on the echocardiographic phenotype in this population are inconsistent and do not consider the effect of modifiable contributors such as blood pressure.
Methods:
This study reports on the echocardiographic findings of the PREMATurity as predictor of children's Cardiovascular-renal Health (PREMATCH) study, a prospective case-control study evaluating renal and cardiovascular outcomes in children with ELBW in comparison to term-born controls. Left ventricular (LV) mass was the primary outcome. Data were analyzed with multivariable-adjusted regression models considering anthropometric variables and systolic blood pressure as covariates.
Results:
Eighty cases (median age, 10.8 years) and 72 controls (median age, 11.4 years) were included. Multivariable-adjusted analyses revealed that the adjusted difference in LV mass in cases versus controls was -8.49 g (CI, -13.78 to -3.20; P=0.002). Sex, height, weight, and body fat percentage were significant covariates. There was a positive interaction between ELBW status and systolic blood pressure (Pinteraction=0.039). There was a -6.47 g (CI, -11.7 to 1.28; P=0.016) difference in LV mass between normotensive cases and controls, while the difference disappeared between subjects with increased blood pressure or hypertension.
Conclusions:
ELBW children exhibit lower LV mass during childhood in comparison with term-born controls. However, elevations in systolic blood pressure are associated with a steeper increase in LV mass in cases than in controls. Our findings question whether cutoffs for the general population are adequate to evaluate and manage hypertension and LV hypertrophy in children with ELBW.
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