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Savio F, Sirico D, Mazzon G, Bonadies L, Guiducci S, Nardo D, Salvadori S, Avesani M, Castaldi B, Baraldi E, Di Salvo G. Cardiac Mechanics Evaluation in Preschool-Aged Children with Preterm Birth History: A Speckle Tracking and 4D Echocardiography Study. J Clin Med 2024; 13:2762. [PMID: 38792304 PMCID: PMC11122247 DOI: 10.3390/jcm13102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The premature-born adult population is set to grow significantly, and prematurity has emerged as an important cardiovascular risk factor. We aimed to comprehensively assess cardiac mechanics and function in a cohort of ex-preterm preschoolers. Methods: Ex-preterm children (<30 weeks of gestation), aged 2 to 5 years, underwent transthoracic 2D, speckle-tracking, and 4D echocardiography. The findings were compared with 19 full-term children. Results: Our cohort of 38 children with prematurity history showed a normal morpho-functional echocardiographic assessment. However, compared to controls, the indexed 3D end-diastolic volumes of ventricular chambers were reduced (left ventricle 58.7 ± 11.2 vs. 67.2 ± 8.5 mL/m2; right ventricle 50.3 ± 10.4 vs. 57.7 ± 11 mL/m2; p = 0.02). Left ventricle global and longitudinal systolic function were worse in terms of fraction shortening (32.9% ± 6.8 vs. 36.5% ± 5.4; p = 0.05), ejection fraction (59.2% ± 4.3 vs. 62.3% ± 3.7; p = 0.003), and global longitudinal strain (-23.6% ± 2.4 vs. -25.5% ± 1.7; p = 0.003). Finally, we found a reduced left atrial strain (47.4% ± 9.7 vs. 54.9% ± 6.8; p = 0.004). Conclusions: Preschool-aged ex-preterm children exhibited smaller ventricles and subclinical impairment of left ventricle systolic and diastolic function compared to term children. Long-term follow-up is warranted to track the evolution of these findings.
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Affiliation(s)
- Federica Savio
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Giada Mazzon
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Silvia Guiducci
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Daniel Nardo
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Sabrina Salvadori
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Martina Avesani
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Biagio Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (F.S.); (S.G.); (D.N.); (S.S.); (E.B.)
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women and Children’s Health, University Hospital of Padova, 35128 Padua, Italy; (G.M.); (M.A.); (B.C.); (G.D.S.)
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Höck M, Posod A, Odri Komazec I, Griesmaier E, Ralser E, Pupp-Peglow U, Kiechl-Kohlendorfer U. Cardiac biomarkers and left ventricular systolic function in former very preterm infants and term controls at preschool age. Front Pediatr 2024; 12:1376360. [PMID: 38590770 PMCID: PMC10999603 DOI: 10.3389/fped.2024.1376360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Due to improvements in perinatal care, survival rates of preterm infants have improved during the last decades. However, these infants remain at risk of developing cardiovascular sequelae later in life. This study aimed to investigate the cardiac biomarkers and left ventricular systolic function in former preterm infants in comparison with term controls at preschool age. Methods The study included children aged 5-7 years old born below 32 weeks of gestational age. The control group consisted of same-age children born at term. Basic data of study participants were collected using questionnaires and follow-up databases. During the study visit, we recorded anthropometric data and blood pressure readings, determined high-sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) concentrations, and calculated fractional shortening (FS) and left ventricular mass (LVM). Results Term-born (n = 25; median gestational age, 40.1 weeks) compared with preterm-born infants (n = 80; median gestational age 29.6 weeks) showed no significant differences in the median concentration of hs-cTnT [median, 3.5 (IQR 3.5; 3.5) vs. 3.5 (3.5; 3.5) ng/L, p = 0.328] and the median concentration of NT-pro-BNP [median, 91.0 (IQR 40.8; 150.3) vs. 87.5 (50.1; 189.5) ng/L, p = 0.087]. FS and LVM/LVMI were not significantly different between the two groups. Conclusion At preschool age, we observed no significant differences in cardiac biomarkers and left ventricular systolic function in preterm infants. Further studies are warranted to explore the potential of cardiac biomarkers as a prognostic tool for subclinical cardiac alterations after preterm birth.
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Affiliation(s)
- Michaela Höck
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Posod
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irena Odri Komazec
- Department of Pediatrics III, Division of Cardiology, Pulmonology, Allergology and Cystic Fibrosis, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Griesmaier
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Ralser
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ulrike Pupp-Peglow
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
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Liefke J, Sepúlveda-Martinez A, Shakya S, Ehrenborg KS, Arheden H, Morsing E, Ley D, Heiberg E, Hedström E. Early-Onset Fetal Growth Restriction Increases Left Ventricular Sphericity in Adolescents Born Very Preterm. Pediatr Cardiol 2023:10.1007/s00246-023-03265-z. [PMID: 37596421 DOI: 10.1007/s00246-023-03265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023]
Abstract
Left ventricular shape alterations predict cardiovascular outcomes and have been observed in children born preterm and after fetal growth restriction (FGR). The aim was to investigate whether left ventricular shape is altered in adolescents born very preterm and if FGR has an additive effect. Adolescents born very preterm due to verified early-onset FGR and two control groups with birthweight appropriate for gestational age (AGA), born at similar gestational age and at term, respectively, underwent cardiac MRI. Principal component analysis was applied to find the modes of variation best explaining shape variability for end-diastole, end-systole, and for the combination of both, the latter indicative of function. Seventy adolescents were included (13-16 years; 49% males). Sphericity was increased for preterm FGR versus term AGA for end-diastole (36[0-60] vs - 42[- 82-8]; p = 0.01) and the combined analysis (27[- 23-94] vs - 51[- 119-11]; p = 0.01), as well as for preterm AGA versus term AGA for end-diastole (30[- 56-115] vs - 42[- 82-8]; p = 0.04), for end-systole (57[- 29-89] vs - 30[- 79-34]; p = 0.03), and the combined analysis (44[- 50-145] vs - 51[- 119-11]; p = 0.02). No group differences were observed for left ventricular mass or ejection fraction (all p ≥ 0.33). Sphericity was increased after very preterm birth and exacerbated by early-onset FGR, indicating an additive effect to that of very preterm birth on left ventricular remodeling. Increased sphericity may be a prognostic biomarker of future cardiovascular disease in this cohort that as of yet shows no signs of cardiac dysfunction using standard clinical measurements.
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Affiliation(s)
- Jonas Liefke
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Alvaro Sepúlveda-Martinez
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico de La Universidad de Chile, Santiago de Chile, Chile
| | - Snehlata Shakya
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Morsing
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - David Ley
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden.
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Radiology, Skåne University Hospital, Lund, Sweden.
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Moore SS, De Carvalho Nunes G, Villegas Martinez D, Dancea A, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna G, Altit G. Association of Gestational Age at Birth With Left Cardiac Dimensions at Near-Term Corrected Age Among Extremely Preterm Infants. J Am Soc Echocardiogr 2023; 36:867-877. [PMID: 37044171 DOI: 10.1016/j.echo.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Remodeling and altered ventricular geometry have been described in adults born preterm. Although they seem to have an adverse cardiac phenotype, the impact of various degrees of prematurity on cardiac development has been scarcely reported. In this study, we evaluated the impact of gestational age (GA) at birth on cardiac dimensions and function at near-term age among extremely preterm infants. METHODS This is a retrospective single-center cohort study of infants born at <29 weeks of GA between 2015 and 2019. Infants with available clinically acquired echocardiography between 34 and 43 weeks were included. Two groups were investigated: those born <26 weeks and those born ≥26 weeks. All measurements were done by an expert masked to clinical data using the raw images. The primary outcome was measurements of cardiac dimensions and function based on GA group. Secondary outcomes were the association between cardiac dimensions and postnatal steroid exposure and with increments of GA at birth. RESULTS A total of 205 infants were included (<26 weeks, n = 102; ≥26 weeks, n = 103). At time of echocardiography, weight (2.4 ± 0.5 vs 2.5 ± 0.5 kg, P = .86) and age (37.2 ± 1.6 vs 37.1 ± 1.9 weeks, P = .74) were similar between groups. There was no difference in metrics of right-sided dimensions and function. However, left-sided dimensions were decreased in infants born <26 weeks, including systolic left ventricle (LV) diameter (1.06 ± 0.20 cm vs 1.12 ± 0.18 cm, P = .02), diastolic LV length (2.85 ± 0.37 vs 3.02 ± 0.57 cm, P = .02), and estimated LV end-diastolic volume (5.36 ± 1.69 vs 6.01 ± 1.79 mL, P = .02). CONCLUSIONS In our cohort of very immature infants, birth at the extreme of prematurity was associated with smaller left cardiac dimensions around 36 weeks of corrected age. Future longitudinal prospective studies should evaluate further the impact of prematurity on LV development and performance and their long-term clinical impact.
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Affiliation(s)
- Shiran Sara Moore
- Department of Neonatology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabriela De Carvalho Nunes
- Department of Neonatology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Daniela Villegas Martinez
- Department of Neonatology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Adrian Dancea
- Department of Pediatric Cardiology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Punnanee Wutthigate
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jessica Simoneau
- Department of Pediatric Cardiology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Marc Beltempo
- Department of Neonatology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Guilherme Sant'Anna
- Department of Neonatology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Gabriel Altit
- Department of Neonatology, McGill University Health Centre, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
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Pavlyukova EN, Kolosova MV, Neklyudova GV, Karpov RS. Features of left ventricle longitudinal strain in children from one to five years old, born with low, very low, and extremely low body weight. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2023-68-1-56-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Purpose. The study assessed left ventricle longitudinal strain of the endocardial, middle, and epicardial layers in children from one to five years old, born with low, very low, and extremely low body weight.Material and methods. The study was performed in 204 children aged from one to five years; of these, 53 children were prematurely born late in pregnancy, 103 children were born very preterm, and 48 children were born healthy and full-term. The left ventricle longitudinal strain of the endocardial, middle, and epicardial layers was assessed off-line using the Speckle Tracking Imaging-2D Strain technology.Results. Disturbance of the transmural gradient strain of left ventricle wall were detected in 11.32% of prematurely born late in pregnancy children and in 16.5% of very preterm children. A decrease of left ventricle segments strain was registered in 33.96% of children prematurely born late in pregnancy and in 18.44% very preterm children. In children of the same age, born healthy and full-term, transmural wall gradient disturbances and decrease of strain in left ventricle segments were not observed. In children prematurely born late in pregnancy, the disturbance of the transmural strain gradient of left ventricle and the decrease of strain in left ventricle segments are not associated with left ventricle remodeling.Conclusion. The development of the cardiovascular system in children of early and preschool age, born prematurely with low, very low, and extremely low body weight, is characterized by disturbances in the transmural strain gradient of left ventricle wall, due to the processes of postnatal growth and development of the child’s heart, which requires monitoring on an outpatient basis in polyclinic in childhood — by a pediatric cardiologist and a pediatrician, and in adulthood — by a cardiologist and therapist.
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Affiliation(s)
- E. N. Pavlyukova
- National Research Medical Center of the Russian Academy of Sciences
| | | | - G. V. Neklyudova
- National Research Medical Center of the Russian Academy of Sciences
| | - R. S. Karpov
- National Research Medical Center of the Russian Academy of Sciences
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Ivanova VV, Milto IV, Serebryakova ON, Sukhodolo IV. Effect of preterm birth in rats on proliferation and hyperplasia of cardiomyocytes. BULLETIN OF SIBERIAN MEDICINE 2023. [DOI: 10.20538/1682-0363-2022-4-72-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aim. To identify the effect of preterm birth on proliferation and hyperplasia of cardiomyocytes in the early postnatal period of ontogenesis in rats.Materials and methods. Preterm birth (on day 21 and 21.5 of gestation) in Wistar rats was induced by subcutaneous administration of mifepristone. Immunohistochemistry was used to identify and calculate the number of Ki67-positive and Mklp2-positive cardiomyocytes in the left ventricle of preterm and full-term rats on days 1, 2, 3, 4, 5, and 6 of postnatal ontogenesis. Statistical analysis of morphometric parameters was performed using the Shapiro – Wilk test and Mann – Whitney test with the Bonferroni correction.Results. We revealed an increase in the number of Ki67-positive cardiomyocytes in the left ventricle of the rats: on day 1 of postnatal ontogenesis (in the rats born on day 21 of gestation) and on days 3–5 of postnatal ontogenesis (in the rats born on day 21.5 of gestation). Preterm birth in rats did not result in a change in the number of Mklp2-positive cardiomyocytes in the left ventricular wall.Conclusion. A change in the pattern of Ki67 expression by cardiomyocytes in the rats born 12 or 24 hours before full term was demonstrated in the early postnatal period of ontogenesis. An isolated increase in Ki67 expression without a change in Mklp2 expression by cardiomyocytes in the left ventricular wall of preterm rats indicates acceleration of cardiomyocyte hypertrophy. Shorter duration of prenatal development is associated with more pronounced morphological and functional rearrangements in the rat myocardium.
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Affiliation(s)
| | - I. V. Milto
- Siberian State Medical University;
Seversk Biophysical Research Center
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Schuermans A, den Harink T, Raman B, Smillie RW, Alsharqi M, Mohamed A, Lapidaire W, van Deutekom AW, Leeson P, Lewandowski AJ. Differing Impact of Preterm Birth on the Right and Left Atria in Adulthood. J Am Heart Assoc 2022; 11:e027305. [PMID: 36453643 PMCID: PMC9851437 DOI: 10.1161/jaha.122.027305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/17/2022] [Indexed: 12/02/2022]
Abstract
Background Preterm birth affects 10% of live births and is associated with an altered left ventricular and right ventricular phenotype and increased cardiovascular disease risk in young adulthood. Because left atrial (LA) and right atrial (RA) volume and function are known independent predictors of cardiovascular outcomes, we investigated whether these were altered in preterm-born young adults. Methods and Results Preterm-born (n=200) and term-born (n=266) adults aged 18 to 39 years underwent cardiovascular magnetic resonance imaging. LA and RA maximal and minimal volumes (absolute, indexed to body surface area, and as a ratio to ventricular volumes) were obtained to study atrial morphology, while LA and RA stroke volume, strain, and strain rate were used to assess atrial function. Secondary analyses consisted of between-group comparisons based on degree of prematurity. Absolute RA volumes and RA volumes indexed to right ventricular volumes were significantly smaller in preterm-born compared with term-born adults. In addition, RA reservoir and booster strain were higher in preterm-born adults, possibly indicating functional compensation for the smaller RA volumes. LA volumes indexed to left ventricular volumes were significantly greater in preterm-born adults as compared with term-born adults, although absolute LA volumes were similar between groups. LA and RA changes were observed across gestational ages in the preterm group but were greatest in those born very-to-extremely preterm. Conclusions Preterm-born adults show changes in LA and RA structure and function, which may indicate subclinical cardiovascular disease. Further research into underlying mechanisms, opportunities for interventions, and their prognostic value is warranted.
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Affiliation(s)
- Art Schuermans
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium
| | - Tamara den Harink
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Department of Epidemiology and Data Science, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Robert W. Smillie
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Maryam Alsharqi
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Department of Cardiac TechnologyCollege of Applied Medical Sciences, Imam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Afifah Mohamed
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Department of Diagnostic Imaging & Applied Health Sciences, Faculty of Health SciencesUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Winok Lapidaire
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Arend W. van Deutekom
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Department of Paediatrics, Division of Paediatric CardiologyErasmus MC‐Sophia Children’s HospitalRotterdamThe Netherlands
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Adam J. Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
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Kumar VHS. Cardiovascular Morbidities in Adults Born Preterm: Getting to the Heart of the Matter! CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121843. [PMID: 36553286 PMCID: PMC9777245 DOI: 10.3390/children9121843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Advances in perinatal and neonatal care have led to improved survival of preterm infants into adulthood. However, the shift in focus to long-term health in adults born preterm requires a clear understanding of the impact of prematurity on developing organ systems and the development of adult-oriented disease. A less well-recognized area of risk for surviving preterm infants is their cardiometabolic health. Epidemiologic evidence has linked preterm birth to the development of systemic hypertension, type 2 diabetes, metabolic syndrome, heart failure, and ischemic heart disease. Of more significant concern is that the risk of cardiometabolic disorders is higher in adults born preterm compared to full-term infants. The interconnected nature of the cardio-pulmonary system means worsening morbidity and mortality in adults born preterm. Addressing the problems of adults born preterm holistically would help promote cardiovascular health, wellness, and quality of life over their lifetime. Recognizing that adults born preterm are a unique subset of the population is a challenge in the current healthcare environment. Addressing issues relevant to adults born preterm in the clinically and research domain, using technology to characterize cardiopulmonary physiology and exercise tolerance, developing screening tools for early diagnosis and treatment, and robust follow-up of these infants with access to longitudinal data would improve both the quality and longevity of life in adults born preterm.
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Affiliation(s)
- Vasantha H S Kumar
- Division of Neonatology, Department of Pediatrics, John R Oishei Children's Hospital, University at Buffalo, 1001 5th Floor Main Street, Buffalo, NY 14203, USA
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Wang S, Fu J, Wu L, Liu XY, Zhang Y. Percentile curves of normal echocardiographic measurements values for left heart structures in 1570 Han Chinese preterm and term infants. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1331-1337. [PMID: 35844083 DOI: 10.1002/jcu.23252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was designed to evaluate echocardiographic measurements in Han Chinese preterm and term infants and to build percentile curves of normal echocardiographic measurements values related to the weight. METHOD From December 2014 to December 2021, a total of 797 male infants and 773 female infants born in * were included in the study. The echocardiographic measurements of each subject were as follows: left ventricular internal diameter at end-diastole (LVIDd), left ventricular internal diameter at end-systole (LVIDs), left ventricular posterior wall thickness at end-diastole (LVPWd), left ventricular posterior wall thickness at end-systole (LVPWs), interventricular septal thickness at end-diastole (IVSd), interventricular septal thickness at end-systole (IVSs), ascending aorta diameter (AO), left atrium (LA) dimension, left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) and left ventricular mass (LVM). The correlations between echocardiography measurements and birth weight (BW), length (L), gestational age (GA), and body surface area (BSA) were analyzed. RESULTS There was a good correlation between the echocardiographic measurements and birth weight and percentile curves of the echocardiographic measurements were established according to different birth weight. The echocardiographic measurements were not affected by gender. However, LVEF and LVFS did not change with BW or gender. CONCLUSIONS The percentile curves of normal values make it possible to classify echocardiographic measurements for left heart structures and function as normal or abnormal and is helpful for the diagnosis of neonatal heart disease in preterm and term infants.
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Affiliation(s)
- Shanshan Wang
- Department of Pediatrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jihe Fu
- Department of Ultrasound, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Lijun Wu
- Department of Echocardiography, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xing-Yuan Liu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuqi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Bertagnolli M, Dartora DR, Lamata P, Zacur E, Mai-Vo TA, He Y, Beauchamp L, Lewandowski AJ, Cloutier A, Sutherland MR, Santos RAS, Nuyt AM. Reshaping the Preterm Heart: Shifting Cardiac Renin-Angiotensin System Towards Cardioprotection in Rats Exposed to Neonatal High-Oxygen Stress. Hypertension 2022; 79:1789-1803. [PMID: 35588210 PMCID: PMC9278707 DOI: 10.1161/hypertensionaha.122.19115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Approximately 10% of infants are born preterm. Preterm birth leads to short and long-term changes in cardiac shape and function. By using a rat model of neonatal high-oxygen (80%O2) exposure, mimicking the premature hyperoxic transition to the extrauterine environment, we revealed a major role of the renin-angiotensin system peptide Angio II (angiotensin II) and its receptor AT1 (angiotensin receptor type 1) on neonatal O2-induced cardiomyopathy. Here, we tested whether treatment with either orally active compounds of the peptides Angio-(1-7) or alamandine included in cyclodextrin could prevent postnatal cardiac remodeling and the programming of cardiomyopathy induced by neonatal high-O2 exposure. METHODS Sprague-Dawley pups were exposed to room air or 80% O2 from postnatal day 3 (P3) to P10. Neonatal rats were treated orally from P3 to P10 and assessed at P10 and P28. Left ventricular (LV) shapes were characterized by tridimensional computational atlases of ultrasound images in addition to histomorphometry. RESULTS At P10, high O2-exposed rats presented a smaller, globular and hypertrophied LV shape versus controls. Treatment with cyclodextrin-Angio-(1-7) significantly improved LV function in the O2-exposed neonatal rats and slightly changed LV shape. Cyclodextrin-alamandine and cyclodextrin-Angio-(1-7) treatments similarly reduced hypertrophy at P10 as well as LV remodeling and dysfunction at P28. Both treatments upregulated cardiac angiotensin-converting enzyme 2 in O2-exposed rats at P10 and P28. CONCLUSIONS Our findings demonstrate LV remodeling changes induced by O2-stress and the potential benefits of treatments targeting the cardioprotective renin-angiotensin system axis, supporting the neonatal period as an important window for interventions aiming at preventing cardiomyopathy in people born preterm.
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Affiliation(s)
- Mariane Bertagnolli
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.).,Research Center of the Hospital Sacré-Coeur, CIUSSS Nord-de-l'Île-de-Montréal, Canada (M.B.).,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Canada (M.B.)
| | - Daniela R Dartora
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.).,Instituto de Cardiologia de Porto Alegre, Fundação Universitária de Cardiologia, Brazil (D.R.D.)
| | - Pablo Lamata
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (P.L., E.Z.)
| | - Ernesto Zacur
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (P.L., E.Z.)
| | - Thuy-An Mai-Vo
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.)
| | - Ying He
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.)
| | - Léonie Beauchamp
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.)
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (A.J.L.)
| | - Anik Cloutier
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.)
| | - Megan R Sutherland
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.).,Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia (M.R.S.)
| | - Robson A S Santos
- Department of Physiology, Instituto Nacional de Ciência e Tecnologia - Nanobiofar, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (R.A.S.S.)
| | - Anne Monique Nuyt
- Sainte-Justine University Hospital Research Center, Université de Montréal, Canada (M.B., D.R.D., T.-A.M.-V., Y.H., L.B., A.C., M.R.S., A.M.N.)
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11
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Markopoulou P, Papanikolaou E, Loukopoulou S, Galina P, Papassotiriou I, Siahanidou T. Elevated circulating endothelial microparticles (EMPs) in prepubertal children born preterm. Pediatr Res 2022; 91:1754-1761. [PMID: 34285352 DOI: 10.1038/s41390-021-01655-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Endothelial microparticles (EMPs) act as early biomarkers of endothelial activation and damage. No studies have investigated EMPs in preterm-born individuals. METHODS Sixty-three preterm-born children and 52 children born full-term (controls) were studied. Circulating CD62E(+), CD144(+), and CD31(+)/CD42b(-) EMPs were measured in preterm-born children compared to controls; possible associations with cardiovascular risk factors and endothelial function parameters were also assessed. RESULTS Circulating CD62E(+), CD144(+), and CD31(+)/CD42b(-) EMPs were significantly higher in preterm-born children compared to controls (p = 0.003, p < 0.001, and p < 0.001, respectively). Preterm birth was recognized as an independent predictor of each EMP subpopulation studied; moreover, the mean pressure and velocity of pulmonary artery were independently correlated with CD62E(+) (β = 0.20, p = 0.04) and CD144(+) EMPs (β = 0.22, p = 0.02), respectively, whereas age (β = 0.21, p = 0.03) and being born SGA (β = 0.26, p = 0.01) correlated independently with CD31(+)/CD42b(-) EMPs in the study population. Furthermore, diastolic blood pressure (β = 0.24, p = 0.04), being born SGA (β = 0.24, p = 0.04) and the hyperemic peak velocity of the brachial artery (β = -0.65, p = 0.02) were independently associated with CD31(+)/CD42b(-) EMPs in the preterm-born group. CONCLUSION Circulating EMPs were higher in preterm-born children compared to children born full-term. Whether EMPs could act, in clinical practice, as a complementary tool for non-invasive evaluation of endothelium in preterm-born children, remains under investigation. IMPACT Circulating endothelial microparticles (EMPs) are small membrane vesicles released from endothelial cells and they act as novel biomarkers of endothelial activation and damage. No studies have investigated circulating EMPs in preterm-born individuals. Circulating EMPs were significantly higher in prepubertal preterm-born children compared to children born at term. In the preterm-born group, the hyperemic peak velocity of the brachial artery was independently associated with CD31(+)/CD42b(-) EMPs. Whether assessment of circulating EMPs could act, in clinical practice, as a complementary tool for non-invasive evaluation of endothelium in preterm-born children, remains to be defined in future investigations.
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Affiliation(s)
- Panagiota Markopoulou
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Papanikolaou
- Laboratory of Biology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sofia Loukopoulou
- Department of Cardiology, "Aghia Sofia" Children's Hospital, Athens, Greece
| | - Paraskevi Galina
- Radiology Department, "Aghia Sofia" Children's Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sofia" Children's Hospital, Athens, Greece
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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12
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Chang HY, Chang JH, Peng CC, Hsu CH, Ko MHJ, Hung CL, Chen MR. Subclinical Changes in Left Heart Structure and Function at Preschool Age in Very Low Birth Weight Preterm Infants. Front Cardiovasc Med 2022; 9:879952. [PMID: 35600491 PMCID: PMC9120602 DOI: 10.3389/fcvm.2022.879952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Hung-Yang Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chun-Chih Peng
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Mary Hsin-Ju Ko
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Pediatrics, Hsinchu MacKay Hospital, Hsinchu, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
- *Correspondence: Ming-Ren Chen
| | - Ming-Ren Chen
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Chung-Lieh Hung
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13
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Bongers-Karmaoui MN, Jaddoe VW, Roest AA, Helbing WA, Steegers EA, Gaillard R. Associations of maternal angiogenic factors during pregnancy with alterations in cardiac development in childhood at 10 years of age. Am Heart J 2022; 247:100-111. [PMID: 35123935 DOI: 10.1016/j.ahj.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine whether maternal angiogenic factors in the first half of pregnancy are associated with offspring left and right cardiac development. METHODS In a population-based prospective cohort among 2,415 women and their offspring, maternal first and second trimester plasma PlGF and sFlt-1 concentrations were measured. Cardiac MRI was performed in their offspring at 10 years. RESULTS Maternal angiogenic factors were not associated with childhood cardiac outcomes in the total population. In children born small-for-their-gestational-age, higher maternal first trimester PlGF concentrations were associated with a lower childhood left ventricular mass (-0.24 SDS [95%CI -0.42, -0.05 per SDS increase in maternal PlGF]), whereas higher sFlt-1 concentrations were associated with higher childhood left ventricular mass (0.22 SDS [95%CI 0.09, 0.34 per SDS increase in maternal sFlt-1]). Higher second trimester maternal sFlt-1 concentrations were also associated with higher childhood left ventricular mass (P-value <.05). In preterm born children, higher maternal first and second trimester sFlt-1/PlGF ratio were associated with higher childhood left ventricular mass (0.30 SDS [95%CI 0.01, 0.60], 0.22 SDS [95%CI -0.03, 0.40]) per SDS increase in maternal sFlt-1/PlGF ratio in first and second trimester respectively). No effects on other childhood cardiac outcomes were present within these higher-risk children. CONCLUSIONS In a low-risk population, maternal angiogenic factors are not associated with childhood cardiac ventricular structure, and function within the normal range. In children born small for their gestational age or preterm, an imbalance in maternal angiogenic factors in the first half of pregnancy was associated with higher childhood left ventricular mass only.
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14
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Schuermans A, Lewandowski AJ. Understanding the Preterm Human Heart: What do We Know So Far? Anat Rec (Hoboken) 2022; 305:2099-2112. [PMID: 35090100 PMCID: PMC9542725 DOI: 10.1002/ar.24875] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/15/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022]
Abstract
Globally, preterm birth affects more than one in every 10 live births. Although the short‐term cardiopulmonary complications of prematurity are well known, long‐term health effects are only now becoming apparent. Indeed, preterm birth has been associated with elevated cardiovascular morbidity and mortality in adulthood. Experimental animal models and observational human studies point toward changes in heart morphology and function from birth to adulthood in people born preterm that may contribute to known long‐term risks. Moreover, recent data support the notion of a heterogeneous cardiac phenotype of prematurity, which is likely driven by various maternal, early, and late life factors. This review aims to describe the early fetal‐to‐neonatal transition in preterm birth, the different structural and functional changes of the preterm human heart across developmental stages, as well as potential factors contributing to the cardiac phenotype of prematurity.
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Affiliation(s)
- Art Schuermans
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.,Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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15
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Änghagen O, Engvall J, Gottvall T, Nelson N, Nylander E, Bang P. Developmental Differences in Left Ventricular Strain in IUGR vs. Control Children the First Three Months of Life. Pediatr Cardiol 2022; 43:1286-1297. [PMID: 35333947 PMCID: PMC9293814 DOI: 10.1007/s00246-022-02850-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) may directly affect cardiovascular function in early life. Longitudinal data on left ventricular longitudinal strain (LVLS), a key measure of cardiac function independent of body size, is not available. We hypothesize impaired cardiac function among IUGR newborns and persistence of the impairment until age 3 months. METHOD This is a prospective cohort study of consecutive pregnancies where IUGR was identified at 18-38 weeks gestational age (GA) with healthy controls randomly selected at 18-20 weeks GA. Echocardiograms were performed at birth and at age 3-4 months, and then compared. RESULTS At birth, mean (SD) LVLS did not differ between the IUGR group [N = 19; - 15.76 (3.12) %] and controls [N = 35; - 15.53 (3.56) %]. The IUGR group demonstrated no significant change in LVLS at age 3-4 months [- 17.80 (3.82) %], while the control group [- 20.91 (3.31) %] showed a significant increase (P < 0.001). Thus, LVLS was lower in the IUGR group at age 3-4 months (P = 0.003). CONCLUSION The lack of increase in LVLS may suggest that IUGR has a direct impact on cardiac function as early as during the first months of life. Trial registration Clinical trials.gov Identifier: NCT02583763, registration October 22, 2015. Retrospectively registered September 2014-October 2015, thereafter, registered prospectively.
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Affiliation(s)
- Olov Änghagen
- Crown Princess Victoria's Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Jan Engvall
- grid.5640.70000 0001 2162 9922Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tomas Gottvall
- grid.5640.70000 0001 2162 9922Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nina Nelson
- grid.5640.70000 0001 2162 9922Crown Princess Victoria’s Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.24381.3c0000 0000 9241 5705National Highly Specialized Care, Karolinska University Hospital Stockholm, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- grid.5640.70000 0001 2162 9922Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Bang
- grid.5640.70000 0001 2162 9922Crown Princess Victoria’s Child and Youth Hospital, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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16
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Bongers-Karmaoui MN, Jaddoe VWV, Gaillard R. Associations of maternal angiogenic factors during pregnancy with childhood carotid intima-media thickness and blood pressure. Atherosclerosis 2021; 338:46-54. [PMID: 34823204 PMCID: PMC7613754 DOI: 10.1016/j.atherosclerosis.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
Background and aims Reduced maternal placental growth factor (PlGF) and higher soluble fms-like tyrosine kinase (sFlt-1) concentrations in pregnancy may have persistent effects on offspring vasculature. We hypothesized that suboptimal maternal angiogenic factors in pregnancy may adversely affect fetal vascular development, leading to an increased risk of adverse atheriosclerotic adaptations and higher blood pressure in offspring. Methods In a population-based prospective cohort among 4565 women and their offspring, we examined the associations of maternal serum PlGF and sFlt-1 concentrations in the first half of pregnancy with offspring vascular development. We measured childhood blood pressure and obtained childhood carotid intima media thickness and carotid distensibility through ultrasonography at 9 years. Results After adjustment for maternal sociodemographic and lifestyle characteristics, no associations were present of maternal first and second trimester angiogenic factors with childhood blood pressure, carotid intima media thickness (IMT) or distensibility in the total population. In preterm born children only, higher maternal second trimester PlGF concentrations, but not sFlt-1 concentrations, were associated with a lower childhood diastolic blood pressure (difference: -0.16 SDS (95% CI -0.30, –0.03) per SDS increase in maternal second trimester PlGF concentration). No associations among children born small-for-gestational age were present. Conclusions In a low-risk population, maternal angiogenic factors in the first half of pregnancy are not associated with childhood blood pressure, carotid IMT or carotid distensibility after considering maternal socio-demographic and lifestyle factors. Only in children born preterm, lower maternal second trimester PlGF concentrations are associated with higher childhood diastolic blood pressure, but not with other vascular outcomes.
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Affiliation(s)
- Meddy N Bongers-Karmaoui
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands.
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17
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Jian M, He S, Liu Y, Liu X, Gui J, Zheng M, Feng B, Zhang X, Liu C. The high-risk factors of different severities of bronchopulmonary dysplasia (BPD) based on the national institute of child health and human development (NICHD) diagnosis criteria in 2018. J Bras Pneumol 2021; 47:e20210125. [PMID: 34614093 PMCID: PMC8642818 DOI: 10.36416/1806-3756/e20210125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the clinical characteristics of preterm infants with different severities of bronchopulmonary dysplasia (BPD) and disclose the high-risk factors of exacerbating BPD. Methods Collection of clinical data of 91 preterm infants admitted to the NICU and diagnosed with BPD, categorized in groups according to the disease severity: 41 mild cases,, 24 moderate cases, and 26 severe cases. Comparison and analysis of perinatal risk factors, treatment, complications and prognosis of the infants with different severity degrees. Results The severe group had a higher proportion of infants with congenital heart disease (CHD) higher than the moderate group (P < 0.05), and a higher ratio of pneumonia and mechanical ventilation (MV) ≥ seven days than the mild group (P < 0.05). The severe group also presented higher reintubation incidence than both the mild and moderate groups (P < 0.05). The groups presented different (P < 0.05) incidence rates of hemodynamically significant patent ductus arteriosus (hsPDA) . Ridit analysis suggested that the premature infants (PIs) with hsPDA, multiple microbial pulmonary infections, or Klebsiella pneumoniae pneumonia had more severe illness. Conclusion CHD, hsPDA, MV ≥ seven days, reintubation, pneumonia, especially multiple microbial pulmonary infections, and Klebsiella pneumoniae pneumonia are correlated with the severity of BPD and can be used as BPD progression predictor.
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Affiliation(s)
- Minqiao Jian
- Department of Clinical Medicine, School of Medicine, South China University of Technology, Guangzhou, China.,Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaoru He
- Department of Clinical Medicine, School of Medicine, South China University of Technology, Guangzhou, China.,Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yumei Liu
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoqing Liu
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juan Gui
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Manli Zheng
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bowen Feng
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohui Zhang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Caisheng Liu
- Department of Clinical Medicine, School of Medicine, South China University of Technology, Guangzhou, China
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18
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Postnatal Expression Profile of MicroRNAs Associated with Cardiovascular Diseases in 3- to 11-Year-Old Preterm-Born Children. Biomedicines 2021; 9:biomedicines9070727. [PMID: 34202871 PMCID: PMC8301298 DOI: 10.3390/biomedicines9070727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 01/07/2023] Open
Abstract
(1) Background: Preterm-born children have an increased cardiovascular risk with the first clinical manifestation during childhood and/or adolescence. (2) Methods: The occurrence of overweight/obesity, prehypertension/hypertension, valve problems or heart defects, and postnatal microRNA expression profiles were examined in preterm-born children at the age of 3 to 11 years descending from preterm prelabor rupture of membranes (PPROM) and spontaneous preterm birth (PTB) pregnancies. The whole peripheral blood gene expression of 29 selected microRNAs associated with cardiovascular diseases was the subject of our interest. (3) Results: Nearly one-third of preterm-born children (32.43%) had valve problems and/or heart defects. The occurrence of systolic and diastolic prehypertension/hypertension was also inconsiderable in a group of preterm-born children (27.03% and 18.92%). The vast majority of children descending from either PPROM (85.45%) or PTB pregnancies (85.71%) had also significantly altered microRNA expression profiles at 90.0% specificity. (4) Conclusions: Postnatal microRNA expression profiles were significantly influenced by antenatal and early postnatal factors (gestational age at delivery, birth weight of newborns, and condition of newborns at the moment of birth). These findings may contribute to the explanation of increased cardiovascular risk in preterm-born children. These findings strongly support the belief that preterm-born children should be dispensarized for a long time to have access to specialized medical care.
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Hamayun J, Mohlkert LA, Stoltz Sjöström E, Domellöf M, Norman M, Zamir I. Association between Neonatal Intakes and Hyperglycemia, and Left Heart and Aortic Dimensions at 6.5 Years of Age in Children Born Extremely Preterm. J Clin Med 2021; 10:2554. [PMID: 34207785 PMCID: PMC8230069 DOI: 10.3390/jcm10122554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/29/2022] Open
Abstract
Survivors of extremely preterm birth (gestational age < 27 weeks) have been reported to exhibit an altered cardiovascular phenotype in childhood. The mechanisms are unknown. We investigated associations between postnatal nutritional intakes and hyperglycemia, and left heart and aortic dimensions in children born extremely preterm. Postnatal nutritional data and echocardiographic dimensions at 6.5 years of age were extracted from a sub-cohort of the Extremely Preterm Infants in Sweden Study (EXPRESS; children born extremely preterm between 2004-2007, n = 171, mean (SD) birth weight = 784 (165) grams). Associations between macronutrient intakes or number of days with hyperglycemia (blood glucose > 8 mmol/L) in the neonatal period (exposure) and left heart and aortic dimensions at follow-up (outcome) were investigated. Neonatal protein intake was not associated with the outcomes, whereas higher lipid intake was significantly associated with larger aortic root diameter (B = 0.040, p = 0.009). Higher neonatal carbohydrate intake was associated with smaller aorta annulus diameter (B = -0.016, p = 0.008). Longer exposure to neonatal hyperglycemia was associated with increased thickness of the left ventricular posterior wall (B = 0.004, p = 0.008) and interventricular septum (B = 0.004, p = 0.010). The findings in this study indicate that postnatal nutrition and hyperglycemia may play a role in some but not all long-lasting developmental adaptations of the cardiovascular system in children born extremely preterm.
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Affiliation(s)
- Jawwad Hamayun
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 52 Stockholm, Sweden; (L.-A.M.); (M.N.)
| | - Lilly-Ann Mohlkert
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 52 Stockholm, Sweden; (L.-A.M.); (M.N.)
- Department of Pediatric Cardiology, Sachs’ Children and Youth Hospital, Södersjukhuset, 118 83 Stockholm, Sweden
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 87 Umeå, Sweden; (M.D.); (I.Z.)
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 52 Stockholm, Sweden; (L.-A.M.); (M.N.)
- Department of Neonatal Medicine, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Itay Zamir
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 87 Umeå, Sweden; (M.D.); (I.Z.)
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20
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Corrado PA, Barton GP, Macdonald JA, François CJ, Eldridge MW, Goss KN, Wieben O. Altered Right Ventricular Filling at Four-dimensional Flow MRI in Young Adults Born Prematurely. Radiol Cardiothorac Imaging 2021; 3:e200618. [PMID: 34250493 DOI: 10.1148/ryct.2021200618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/08/2021] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Abstract
Purpose To use four-dimensional (4D) flow MRI to measure intraventricular flow in young adults who were born prematurely to investigate mechanisms that may account for increased heart failure risk in this population. Materials and Methods In this secondary analysis of a prospective study, a total of 56 young adults participated in an observational cardiac 4D flow MRI study from 2016 to 2020. There were 35 participants who had been born moderately to extremely prematurely (birth weight <1500 g or gestational age ≤32 weeks; 23 women; mean age, 26 years ± 4) and 21 term-born participants (11 women; mean age, 25 years ± 3). Participants underwent cardiac MRI, including cine cardiac structure and function assessment, as well as 4D flow MRI. In each ventricle, normalized kinetic energy (KE/end diastolic volume) and flow through the atrioventricular valve were computed and compared between term-born and preterm participants at systolic and diastolic (early diastolic filling rate [E wave] and late diastolic filling [atrial contraction] rate [A wave]) time points by using Wilcoxon rank-sum tests. Results Preterm-born participants had lower right ventricular (RV) E wave/A wave (E/A) KE ratios (2.4 ± 1.7 vs 3.5 ± 1.4; P <.01) and lower E/A peak filling rate ratios (computed from RV volume-time curves; 2.3 ± 1.3 vs 3.5 ± 2.5; P = .03). Additionally, viscous energy dissipation was increased during systole (5.7 µW/mL ± 3.0 vs 4.2 µW/mL ± 1.6; P = .03), increased during late diastole (3.9 µW/mL ± 4.0 vs 2.2 µW/mL ± 1.6; P = .03), and summed over the cardiac cycle (2.4 µJ/mL ± 1.0 vs 1.9 µJ/mL ± 0.6; P = .02) in preterm relative to term participants. Conclusion These results suggest that RV diastolic filling is altered in young adults who were born moderately to severely prematurely.Supplemental material is available for this article. Keywords: Adults, Cardiac, Comparative Studies, MR-Imaging, Right Ventricle © RSNA, 2021.
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Affiliation(s)
- Philip A Corrado
- Departments of Medical Physics, Radiology, Pediatrics, and Medicine, University of Wisconsin-Madison, Madison, Wis (P.A.C., M.W.E., O.W.); Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8558 (G.P.B., K.N.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.A.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.J.F.)
| | - Gregory P Barton
- Departments of Medical Physics, Radiology, Pediatrics, and Medicine, University of Wisconsin-Madison, Madison, Wis (P.A.C., M.W.E., O.W.); Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8558 (G.P.B., K.N.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.A.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.J.F.)
| | - Jacob A Macdonald
- Departments of Medical Physics, Radiology, Pediatrics, and Medicine, University of Wisconsin-Madison, Madison, Wis (P.A.C., M.W.E., O.W.); Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8558 (G.P.B., K.N.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.A.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.J.F.)
| | - Christopher J François
- Departments of Medical Physics, Radiology, Pediatrics, and Medicine, University of Wisconsin-Madison, Madison, Wis (P.A.C., M.W.E., O.W.); Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8558 (G.P.B., K.N.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.A.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.J.F.)
| | - Marlowe W Eldridge
- Departments of Medical Physics, Radiology, Pediatrics, and Medicine, University of Wisconsin-Madison, Madison, Wis (P.A.C., M.W.E., O.W.); Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8558 (G.P.B., K.N.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.A.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.J.F.)
| | - Kara N Goss
- Departments of Medical Physics, Radiology, Pediatrics, and Medicine, University of Wisconsin-Madison, Madison, Wis (P.A.C., M.W.E., O.W.); Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8558 (G.P.B., K.N.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.A.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.J.F.)
| | - Oliver Wieben
- Departments of Medical Physics, Radiology, Pediatrics, and Medicine, University of Wisconsin-Madison, Madison, Wis (P.A.C., M.W.E., O.W.); Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8558 (G.P.B., K.N.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.A.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.J.F.)
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21
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Lê B, Dahl MJ, Albertine KH, Sutherland MR, Black MJ. Preterm Birth With Neonatal Interventions Accelerates Collagen Deposition in the Left Ventricle of Lambs Without Affecting Cardiomyocyte Development. CJC Open 2021; 3:574-584. [PMID: 34036257 PMCID: PMC8134943 DOI: 10.1016/j.cjco.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background Adults born preterm (< 37 weeks’ gestation) exhibit altered cardiac growth and are susceptible to cardiac dysfunction. Sheep studies have shown that moderate preterm birth results in maladaptive structural remodelling of the cardiac ventricles. The aim of this study was to examine ventricular structure in lambs born at a greater severity of preterm birth and ventilated postnatally. Methods Former-preterm lambs delivered at 128 days’ gestation, and mechanically ventilated for a week after birth, were compared with unventilated lambs born at term (150 days’ gestation), at 2 months (term: n = 10, former-preterm: n = 8), and 5 months (term: n = 9, former-preterm: n = 8) term-equivalent age. The right ventricle and left ventricle plus septum were analysed using immunohistochemistry, histology, and stereology. Results Cardiomyocyte number, cross-sectional area, proliferation, and apoptosis were not affected by preterm birth or age. Left ventricle plus septum interstitial collagen levels increased with age (P = 0.0015) and were exacerbated by preterm birth (P = 0.0006; 2 months term: 0.57% ± 0.07%, former-preterm: 1.44% ± 0.18%; 5 months term: 1.37% ± 0.25%, former-preterm: 2.15% ± 0.31%). Right ventricle interstitial collagen levels increased with age (P = 0.012) but were not affected by preterm birth. Conclusion This study is the first to explore the effect of preterm birth combined with modern neonatal interventions on the ventricular myocardium in lambs. There was no adverse impact on cardiomyocyte growth in early postnatal life. Of concern, however, there was increased collagen deposition in the preterm hearts, which has the potential to induce cardiac dysfunction, especially if it becomes exaggerated with ageing.
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Affiliation(s)
- Bianca Lê
- Department of Anatomy and Developmental Biology and Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Mar Janna Dahl
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Kurt H Albertine
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Megan R Sutherland
- Department of Anatomy and Developmental Biology and Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Mary Jane Black
- Department of Anatomy and Developmental Biology and Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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22
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Left Ventricle Phenotyping Utilizing Tissue Doppler Imaging in Premature Infants with Varying Severity of Bronchopulmonary Dysplasia. J Clin Med 2021; 10:jcm10102211. [PMID: 34065264 PMCID: PMC8160781 DOI: 10.3390/jcm10102211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is characterized by alveolar-capillary simplification and is associated with pulmonary hypertension (PH) in preterm infants. The contribution of left ventricle (LV) disease towards this severe BPD-PH phenotype is not well established. We aimed to describe the longitudinal trajectory of the LV function as measured by tissue Doppler imaging (TDI) and its association with BPD-PH. We retrospectively assessed prospectively acquired clinical and echocardiographic data from 77 preterm infants born between 2011 and 2013. We characterized the LV function by measuring systolic and diastolic myocardial velocities (s’, e’, a’), isovolumetric relaxation time (IVRT), and myocardial performance index with TDI at three time periods from 32 and 36 weeks, postmenstrual age through one year of age. We also measured post systolic motion (PSM), a marker of myocardial dysfunction that results from asynchronous movement of the ventricular walls, and not previously described in preterm infants. Patients were stratified into groups according to BPD severity and the presence of PH and compared over time. Conventional TDI measures of the LV function were similar between groups, but the septal PSM was significantly prolonged over the first year of age in patients with BPD-PH. PSM provides a novel objective way to assess the hemodynamic impact of lung and pulmonary vascular disease severity on LV function in preterm infants with BPD and PH.
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23
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Left Ventricle Structure and Function in Young Adults Born Very Preterm and Association with Neonatal Characteristics. J Clin Med 2021; 10:jcm10081760. [PMID: 33919540 PMCID: PMC8072582 DOI: 10.3390/jcm10081760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
Preterm birth increases risk of cardiovascular disease and early death. A body of evidence suggests left ventricle (LV) echocardiographic alterations in children and adults born preterm. We aimed to determine if neonatal characteristics were associated with alterations in LV structure and function in preterm adults. We evaluated a cohort of 86 young adults born preterm below 30 weeks of gestation, and 85 full-term controls. We determined LV dimensions and function using tissue Doppler imaging, conventional and speckle tracking echocardiography (STE). Adults born preterm had smaller LV dimensions, but these differences did not remain after adjustment for body surface area (BSA), which was smaller in the preterm group. Stroke volume and cardiac output were reduced even after adjustment for BSA. We found a smaller e’ wave in the preterm group, but other markers of systolic and diastolic function did not differ. Use of antenatal steroids may be associated with a further reduced cardiac output in those born preterm. Adults born preterm show alterations in markers of LV dimensions and function. Identification of these markers may represent opportunities for early prevention of cardiovascular events in this at-risk population.
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24
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Yu LF, Xu CK, Zhao M, Niu L, Huang XM, Zhang ZQ. Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus. World J Clin Cases 2021; 9:1827-1834. [PMID: 33748231 PMCID: PMC7953406 DOI: 10.12998/wjcc.v9.i8.1827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights. When PDA persists, interstitial lung water content increases, which could lead to abnormal circulation hemodynamics and pulmonary edema. It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA.
AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA.
METHODS From January 2018 to March 2020, 69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group. At the same time, 89 very low-weight preterm neonates without PDA were randomly selected as the control group. All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth. The clinical characteristics and main ultrasonography results were compared between the two groups. Pearson’s analysis was used to analyze the correlation between lung ultrasonography score (LUS) and other related clinical and ultrasonography results in all neonates. In the PDA group, PDA diameters were recorded, and the correlation with LUS and left atrium to aortic (LA/AO) dimension ratio were also analyzed. LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA. When the ratio is ≥ 1.5, it suggests the possibility of hemodynamic changes in persistent PDA. A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa.
RESULTS A total of 158 neonates were enrolled in this study, including 69 in the PDA group and 89 in the control group. There were no statistical differences in sex, gestational age, birth weight, ventilator dependence, hospitalization length and left ventricular ejection fraction between the two groups (P > 0.05). The LUS and LA/AO ratio in the PDA group were higher than those in the control group (P < 0.05), but there was no difference of LUS in neonates with or without use of the ventilator (t = 0.58, P = 0.16). In all cases, LUS was negatively correlated with gestational age (r = -0.28, P < 0.01) and birth weight (r = -0.36, P < 0.01), while positively correlated with the LA/AO ratio (r = 0.27, P < 0.01). In the PDA group, PDA diameter was positively correlated with the LA/AO ratio (r = 0.39, P < 0.01) and LUS (r = 0.31, P < 0.01). Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA (area under the curve = 0.741; sensitivity = 93.75%; specificity = 50.94%).
CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.
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Affiliation(s)
- Li-Fang Yu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Chen-Ke Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Min Zhao
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Lin Niu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xian-Mei Huang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Zhi-Qun Zhang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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25
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Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm-A Population-Based Cohort Study. J Clin Med 2020; 10:jcm10010122. [PMID: 33396414 PMCID: PMC7795537 DOI: 10.3390/jcm10010122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 12/11/2022] Open
Abstract
Preterm birth has been associated with altered cardiac phenotype in adults. Our aim was to test the hypothesis that children surviving extremely preterm birth have important structural or functional changes of the right heart or pulmonary circulation. We also examined relations between birth size, gestational age, neonatal diagnoses of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) with cardiac outcomes. We assessed a population-based cohort of children born in Sweden before 27 weeks of gestation with echocardiography at 6.5 years of age (n = 176). Each preterm child was matched to a healthy control child born at term. Children born preterm had significantly smaller right atria, right ventricles with smaller widths, higher relative wall thickness and higher estimated pulmonary vascular resistance (PVR) than controls. In preterm children, PVR and right ventricular myocardial performance index (RVmpi’) were significantly higher in those with a PDA as neonates than in those without PDA, but no such associations were found with BPD. In conclusion, children born extremely preterm exhibit higher estimated PVR, altered right heart structure and function compared with children born at term.
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26
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Benny M, Hernandez DR, Sharma M, Yousefi K, Kulandavelu S, Batlahally S, Zambrano R, Chen P, Martinez EC, Schmidt AF, Shehadeh LA, Vasquez-Padron RI, Wu S, Velazquez OC, Young KC. Neonatal hyperoxia exposure induces aortic biomechanical alterations and cardiac dysfunction in juvenile rats. Physiol Rep 2020; 8:e14334. [PMID: 31925922 PMCID: PMC6954121 DOI: 10.14814/phy2.14334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Supplemental oxygen (O2) therapy in preterm infants impairs lung development, but the impact of O2 on long‐term systemic vascular structure and function has not been well‐explored. The present study tested the hypothesis that neonatal O2 therapy induces long‐term structural and functional alterations in the systemic vasculature, resulting in vascular stiffness observed in children and young adults born preterm. Newborn Sprague‐Dawley rats were exposed to normoxia (21% O2) or hyperoxia (85% O2) for 1 and 3 weeks. A subgroup exposed to 3 weeks hyperoxia was recovered in normoxia for an additional 3 weeks. Aortic stiffness was assessed by pulse wave velocity (PWV) using Doppler ultrasound and pressure myography. Aorta remodeling was assessed by collagen deposition and expression. Left ventricular (LV) function was assessed by echocardiography. We found that neonatal hyperoxia exposure increased vascular stiffness at 3 weeks, which persisted after normoxic recovery at 6 weeks of age. These findings were accompanied by increased PWV, aortic remodeling, and altered LV function as evidenced by decreased ejection fraction, cardiac output, and stroke volume. Importantly, these functional changes were associated with increased collagen deposition in the aorta. Together, these findings demonstrate that neonatal hyperoxia induces early and sustained biomechanical alterations in the systemic vasculature and impairs LV function. Early identification of preterm infants who are at risk of developing systemic vascular dysfunction will be crucial in developing targeted prevention strategies that may improve the long‐term cardiovascular outcomes in this vulnerable population.
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Affiliation(s)
- Merline Benny
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Diana R Hernandez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Mayank Sharma
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Keyvan Yousefi
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida.,Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Shathiyah Kulandavelu
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Sunil Batlahally
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ronald Zambrano
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Pingping Chen
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Eliana C Martinez
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Augusto F Schmidt
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Lina A Shehadeh
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida.,Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Shu Wu
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Omaida C Velazquez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Karen C Young
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
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27
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Le N, Phad N, de Waal K. Cardiac remodeling during the neonatal intensive care period; a window of opportunity for early prevention of heart failure? Early Hum Dev 2020; 151:105168. [PMID: 32889167 DOI: 10.1016/j.earlhumdev.2020.105168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is growing evidence that preterm birth is a risk factor for early heart failure as a result of cardiac remodeling during a critical period of growth and development. The aim of this study was to explore if cardiac remodeling can be detected very early after preterm birth, and if present, if those remodeling changes persist until discharge. METHODS Echocardiography parameters of left ventricular geometry and function were prospectively obtained with echocardiography in preterm infants <30 weeks gestation at postnatal day 3 and at 36 weeks postmenstrual age (PMA). Findings were compared to available data of healthy fetuses and cardiac remodeling was classified based on changes in left ventricular volume and/or mass. RESULTS 65 (37 male) preterm infants were analysed. Three days after birth, 27.7% of infants had abnormal LV geometry, with immaturity and fetal growth restriction as risk factors for these early cardiac remodeling changes. At 36 weeks PMA, after a median period of 9 weeks of neonatal intensive care, 69.2% had abnormal cardiac geometry which could be classified as dilated hypertrophic remodeling (50.0%), dilated remodeling (11.5%) and hypertrophic remodeling (7.7%). CONCLUSION Cardiac remodeling changes can be detected very early after preterm birth. However, most changes take place during the neonatal intensive care period. The findings of this study could assist in identifying a group where an early and short-term intervention has the potential to prevent a pathway of abnormal cardiac development.
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Affiliation(s)
- Nhu Le
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, NSW, Australia.
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28
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Physical Activity in 6.5-Year-Old Children Born Extremely Preterm. J Clin Med 2020; 9:jcm9103206. [PMID: 33020458 PMCID: PMC7600509 DOI: 10.3390/jcm9103206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/27/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022] Open
Abstract
Physical activity (PA) can prevent cardiovascular diseases. Because of increased risks of impairments affecting motor activity, PA in children born preterm may differ from that in children born at term. In this prospective cohort study, we compared objectively measured PA in 71 children born extremely preterm (<27 weeks gestational age), to their 87 peers born at term, at 6.5 years of age. PA measured with accelerometer on the non-dominant wrist for 7 consecutive days was compared between index and control children and analyzed for associations to prenatal growth, major neonatal brain injury, bronchopulmonary dysplasia and neonatal septicemia, using ANOVA. Boys born extremely preterm spent on average 22 min less time per day in moderate to vigorous physical activity (MVPA) than control boys (95% CI: -8, -37). There was no difference in girls. Amongst children born extremely preterm, major neonatal brain injury was associated with 56 min less time in MVPA per day (95%CI: -88, -26). Subgroups of children born extremely preterm exhibit lower levels of physical activity which may be a contributory factor in the development of cardiovascular diseases as adults.
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29
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Harris SL, Bray H, Troughton R, Elliott J, Frampton C, Horwood J, Darlow BA. Cardiovascular Outcomes in Young Adulthood in a Population-Based Very Low Birth Weight Cohort. J Pediatr 2020; 225:74-79.e3. [PMID: 32553866 DOI: 10.1016/j.jpeds.2020.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess differences in left heart structure and function, and endothelial function in a national cohort of very low birth weight (VLBW) young adults and term-born controls. STUDY DESIGN The New Zealand VLBW study is a prospective, population-based, longitudinal cohort study which included all infants born <1500 g in 1986. The VLBW cohort (n = 229; 71% of survivors) and term-born controls (n = 100), were assessed at age 26-30 years. Measures of left heart structure and function were evaluated by echocardiography, vascular function was assessed using blood pressure, reactive hyperemia index, and arterioventricular coupling by calculating left ventricular (LV) and arterial elastance. RESULTS Compared with controls, those born VLBW had smaller LVs, even when indexed for body surface area (mean LV mass, 89.7 ± 19.3 g/m2 vs 95.0 ± 22.3 g/m2 [P = .03]; LV end-diastolic volume, 58.3 ± 10.9 mL/m2 vs 62.4 ± 12.4 mL/m2 [P = .002]; and LV end-systolic volume, 20.8 ± 4.9 mL/m2 vs 22.6 ± 5.8 mL/m2 [P = .004]). VLBW participants had lower stroke volume (median, 37.2 mL/m2 [IQR, 33-42 mL/m2] vs median, 40.1 mL/m2 [IQR, 34-45 mL/m2]; P = .0059) and cardiac output (mean, 4.8 ± 1.2 L/min vs 5.1 ± 1.4 L/min; P = .03), but there was no difference in ejection fraction. The VLBW group had higher LV elastance (3.37 ± 0.88 mm Hg/mL vs 2.86 ± 0.75 mm Hg/mL; P < .0001) and arterial elastance (1.84 ± 0.4 vs 1.6 ± 0.4; P < .0001) and lower reactive hyperemia index (0.605 ± 0.28 vs 0.688 ± 0.31; P = .041). These measures were influenced by birth weight and sex, but we found limited associations with other perinatal factors. CONCLUSIONS Being born preterm and VLBW is associated with differences in cardiovascular structure and function in adulthood. This population may be more vulnerable to cardiovascular pathology as they age. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12612000995875.
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Affiliation(s)
- Sarah L Harris
- Department of Pediatrics, University of Otago, Christchurch, New Zealand.
| | - Helen Bray
- Christchurch Women's Hospital, Christchurch, New Zealand
| | - Richard Troughton
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - John Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
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Maturational patterns of left ventricular rotational mechanics in pre-term infants through 1 year of age. Cardiol Young 2020; 30:1238-1246. [PMID: 32665043 DOI: 10.1017/s1047951120001912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures. METHODS Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus. RESULTS Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05). CONCLUSION This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.
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31
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Haraldsdottir K, Watson AM, Pegelow DF, Palta M, Tetri LH, Levin T, Brix MD, Centanni RM, Goss KN, Eldridge MM. Blunted cardiac output response to exercise in adolescents born preterm. Eur J Appl Physiol 2020; 120:2547-2554. [DOI: 10.1007/s00421-020-04480-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
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32
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Telles F, McNamara N, Nanayakkara S, Doyle MP, Williams M, Yaeger L, Marwick TH, Leeson P, Levy PT, Lewandowski AJ. Changes in the Preterm Heart From Birth to Young Adulthood: A Meta-analysis. Pediatrics 2020; 146:peds.2020-0146. [PMID: 32636236 DOI: 10.1542/peds.2020-0146] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Preterm birth is associated with incident heart failure in children and young adults. OBJECTIVE To determine the effect size of preterm birth on cardiac remodeling from birth to young adulthood. DATA SOURCES Data sources include Medline, Embase, Scopus, Cochrane databases, and clinical trial registries (inception to March 25, 2020). STUDY SELECTION Studies in which cardiac phenotype was compared between preterm individuals born at <37 weeks' gestation and age-matched term controls were included. DATA EXTRACTION Random-effects models were used to calculate weighted mean differences with corresponding 95% confidence intervals. RESULTS Thirty-two observational studies were included (preterm = 1471; term = 1665). All measures of left ventricular (LV) and right ventricular (RV) systolic function were lower in preterm neonates, including LV ejection fraction (P = .01). Preterm LV ejection fraction was similar from infancy, although LV stroke volume index was lower in young adulthood. Preterm LV peak early diastolic tissue velocity was lower throughout development, although preterm diastolic function worsened with higher estimated filling pressures from infancy. RV longitudinal strain was lower in preterm-born individuals of all ages, proportional to the degree of prematurity (R 2 = 0.64; P = .002). Preterm-born individuals had persistently smaller LV internal dimensions, lower indexed LV end-diastolic volume in young adulthood, and an increase in indexed LV mass, compared with controls, of 0.71 g/m2 per year from childhood (P = .007). LIMITATIONS The influence of preterm-related complications on cardiac phenotype could not be fully explored. CONCLUSIONS Preterm-born individuals have morphologic and functional cardiac impairments across developmental stages. These changes may make the preterm heart more vulnerable to secondary insults, potentially underlying their increased risk of early heart failure.
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Affiliation(s)
- Fernando Telles
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Shane Nanayakkara
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | | | | | - Lauren Yaeger
- Bernard Becker Medical Library, School of Medicine, Washington University in St Louis, St Louis, Missouri; and
| | - Thomas H Marwick
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Philip T Levy
- Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom;
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Goss KN, Haraldsdottir K, Beshish AG, Barton GP, Watson AM, Palta M, Chesler NC, Francois CJ, Wieben O, Eldridge MW. Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults. JAMA Cardiol 2020; 5:910-919. [PMID: 32432648 DOI: 10.1001/jamacardio.2020.1511] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood. Objective To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI). Design, Setting, and Participants This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019. Exposures Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g. Main Outcomes and Measures Main study outcomes included MRI measures of biventricular volume, mass, and strain. Results Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely. Conclusions and Relevance In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.
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Affiliation(s)
- Kara N Goss
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Kristin Haraldsdottir
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Kinesiology, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Arij G Beshish
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Gregory P Barton
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Andrew M Watson
- Department of Orthopedic and Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Mari Palta
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Naomi C Chesler
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Chris J Francois
- Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Oliver Wieben
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Marlowe W Eldridge
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Kinesiology, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison
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Mohlkert L, Sjöberg G, Rydberg A, Pegelow Halvorsen C, Tufvesson E, Hallberg J, Domellöf M, Norman M. Lung function and pulmonary vascular resistance are not associated in 6-year-old children born extremely preterm. Acta Paediatr 2020; 109:746-753. [PMID: 31557349 DOI: 10.1111/apa.15030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Abstract
AIM Children born preterm are at increased risk of reduced lung function. The aim was to test whether lung function was associated with pulmonary vascular resistance. METHODS Participants were recruited from a population-based cohort born in 2004-2007. Lung function was assessed with spirometry after administration of a beta2-agonist. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1 ) were determined. Estimations of pulmonary vascular resistance, arterial dimensions, right ventricular wall thickness, sphericity, and systolic (TAPSE) and diastolic functions were performed with echocardiography. Adjusted regression analyses were used to study associations. RESULTS Sixty-six children (33 boys) born at 22-26 weeks of gestational age (birthweights 460-1134 g) were assessed at a mean age of 6.7 years. Despite large variations in lung function with FVC z-scores ranging from -4.6 to +2.8, there were no associations between lung function and pulmonary arterial pressure, right ventricular structure or function. Children with higher FVC z-scores (r = .52, β = .55 mm, P = .015) and higher FEV1 z-scores (r = .58, β = .73 mm, P = .001) exhibited larger pulmonary arteries. CONCLUSION In children born extremely preterm, lung function was not associated with pulmonary vascular resistance. Routine echocardiographic evaluation of extremely preterm children may not be indicated at age 6.5 years.
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Affiliation(s)
- Lilly‐Ann Mohlkert
- Division of Paediatrics Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Gunnar Sjöberg
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
| | - Annika Rydberg
- Department of Clinical Sciences Paediatrics Umeå University Umeå Sweden
| | - Cecilia Pegelow Halvorsen
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology Lund University Lund Sweden
| | - Jenny Hallberg
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences Paediatrics Umeå University Umeå Sweden
| | - Mikael Norman
- Division of Paediatrics Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of Neonatal Medicine Karolinska University Hospital Stockholm Sweden
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35
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Tanghöj G, Liuba P, Sjöberg G, Naumburg E. Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age. Front Cardiovasc Med 2020; 6:185. [PMID: 31998753 PMCID: PMC6965016 DOI: 10.3389/fcvm.2019.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3–5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. “Cases” were children with ASD closure at ≤1 or ≤2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were ≤2 years, and 50 (12%) were ≤1 year. Risk factors associated with a ≤2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5–3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8–6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6–12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7–4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.
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Affiliation(s)
- Gustaf Tanghöj
- Department of Clinical Sciences, Unit of Pediatrics, Umeå University, Umeå, Sweden
| | - Petru Liuba
- Department of Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Estelle Naumburg
- Department of Clinical Sciences, Unit of Pediatrics, Umeå University, Umeå, Sweden
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Phad NS, de Waal K, Holder C, Oldmeadow C. Dilated hypertrophy: a distinct pattern of cardiac remodeling in preterm infants. Pediatr Res 2020; 87:146-152. [PMID: 31493773 DOI: 10.1038/s41390-019-0568-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/30/2019] [Accepted: 08/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Young adults born preterm have remodeled hearts, i.e., altered cardiac shape and size with impaired cardiac function. At present, the natural history and pattern of prematurity related cardiac remodeling are not clearly established. The aim of this study was to compare the left ventricle (LV) geometry and function of preterm infants at 36 weeks postmenstrual age (PMA) with gestation matched newborn infants. METHODS LV end diastolic volume index (LV EDVI), LV mass index (LVMI), relative wall thickness (RWT), and sphericity index (SI) were prospectively obtained with echocardiography. LV geometry was classified according to the Gaasch method. LV function was assessed by determining ejection fraction (EF), longitudinal strain (LS), mitral annulus systolic motion (s'), and estimated LV filling pressure (E/e'). RESULTS Eighty-three preterm infants between 23 and 29 weeks gestation, and 40 infants of 36 weeks gestation at birth were analysed. LV EDVI, LVMI, SI, LS, s', and E/e' were higher in preterm group while RWT and EF were comparable between groups. LV showed normal geometry in 55.4%, physiological enlargement in 23% and dilated hypertrophy in 21.6% preterm infants. CONCLUSION At 36 week, preterm infants have significantly dilated, hypertrophied, and more spherical LV with impaired diastolic function compared with PMA matched newborn infants.
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Affiliation(s)
- Nilkant S Phad
- John Hunter Children's Hospital, Newcastle, NSW, Australia. .,University of Newcastle, Newcastle, NSW, Australia.
| | - Koert de Waal
- John Hunter Children's Hospital, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
| | - Carl Holder
- Hunter Medical Research Institute, Newcastle, NSW, Australia
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Kumari S, Braun RK, Tetri LH, Barton GP, Hacker TA, Goss KN. Bimodal right ventricular dysfunction after postnatal hyperoxia exposure: implications for the preterm heart. Am J Physiol Heart Circ Physiol 2019; 317:H1272-H1281. [PMID: 31702968 DOI: 10.1152/ajpheart.00383.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rats exposed to postnatal hyperoxia develop right ventricular (RV) dysfunction, mild pulmonary hypertension, and dysregulated cardiac mitochondrial biogenesis when aged to one year, with the degree of cardiac dysfunction and pulmonary hypertension similar to that previously described in young adults born preterm. Here, we sought to understand the impact of postnatal hyperoxia exposure on RV hemodynamic and mitochondrial function across the life span. In Methods, pups from timed-pregnant Sprague-Dawley rats were randomized to normoxia or hyperoxia [fraction of inspired oxygen (FIO2), 0.85] exposure for the first 14 days of life, a commonly used model of chronic lung disease of prematurity. RV hemodynamic and mitochondrial function were assessed by invasive measurement of RV pressure-volume loops and by high-resolution respirometry at postnatal day 21 (P21), P90, and P365. In Results, at P21, hyperoxia-exposed rats demonstrated severe pulmonary hypertension and RV dysfunction, accompanied by depressed mitochondrial oxidative capacity. However, significant upregulation of mitochondrial biogenesis at P21 as well as improved afterload led to complete RV hemodynamic and mitochondrial recovery at P90. Mitochondrial DNA mutations were significantly higher by P90 and associated with significant late RV mitochondrial and hemodynamic dysfunction at P365. In conclusion, there appears to be a "honeymoon period" where cardiac hemodynamic and mitochondrial function normalizes following postnatal hyperoxia exposure, only to decline again with ongoing aging. This finding may have significant implications if a long-term pulmonary vascular screening program were to be developed for children or adults with a history of severe prematurity. Further investigation into the mechanisms of recovery are warranted.NEW & NOTEWORTHY Premature birth is associated with increased risk for cardiac dysfunction and failure throughout life. Here, we identify bimodal right ventricular dysfunction after postnatal hyperoxia exposure. Mitochondrial biogenesis serves as an early adaptive feature promoting recovery of cardiac hemodynamic and mitochondrial function. However, the accumulation of mitochondrial DNA mutations results in late mitochondrial and right ventricular dysfunction. This bimodal right ventricular dysfunction may have important implications for the development of screening programs in the preterm population.
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Affiliation(s)
- Santosh Kumari
- Department of Medicine, School of Medicine and Public Health, University of Madison-Wisconsin, Madison, Wisconsin
| | - Rudolf K Braun
- Department of Pediatrics, School of Medicine and Public Health, University of Madison-Wisconsin, Madison, Wisconsin
| | - Laura H Tetri
- Department of Pediatrics, School of Medicine and Public Health, University of Madison-Wisconsin, Madison, Wisconsin
| | - Gregory P Barton
- Department of Pediatrics, School of Medicine and Public Health, University of Madison-Wisconsin, Madison, Wisconsin
| | - Timothy A Hacker
- University of Wisconsin Cardiovascular Research Center, School of Medicine and Public Health, University of Madison-Wisconsin, Madison, Wisconsin
| | - Kara N Goss
- Department of Medicine, School of Medicine and Public Health, University of Madison-Wisconsin, Madison, Wisconsin.,Department of Pediatrics, School of Medicine and Public Health, University of Madison-Wisconsin, Madison, Wisconsin
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Nikolaidou C, Karamitsos T. The shape of our hearts: The impact of early stages in life on cardiac development. Eur J Prev Cardiol 2019; 27:60-62. [PMID: 31408369 DOI: 10.1177/2047487319869579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Theodoros Karamitsos
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
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Persistence of right ventricular dysfunction and altered morphometry in asymptomatic preterm Infants through one year of age: Cardiac phenotype of prematurity. Cardiol Young 2019; 29:945-953. [PMID: 31287038 PMCID: PMC6715519 DOI: 10.1017/s1047951119001161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Prematurity impacts myocardial development and may determine long-term outcomes. The objective of this study was to test the hypothesis that preterm neonates develop right ventricle dysfunction and adaptive remodelling by 32 weeks post-menstrual age that persists through 1 year corrected age. MATERIALS AND METHODS A subset of 80 preterm infants (born <29 weeks) was selected retrospectively from a prospectively enrolled cohort and measures of right ventricle systolic function and morphology by two-dimensional echocardiography were assessed at 32 weeks post-menstrual age and at 1 year of corrected age. Comparisons were made to 50 term infants at 1 month and 1 year of age. Sub-analyses were performed in preterm-born infants with bronchopulmonary dysplasia and/or pulmonary hypertension. RESULT In both term and preterm infants, right ventricle function and morphology increased over the first year (p < 0.01). The magnitudes of right ventricle function measures were lower in preterm-born infants at each time period (p < 0.01 for all) and right ventricle morphology indices were wider in all preterm infants by 1 year corrected age, irrespective of lung disease. Measures of a) right ventricle function were further decreased and b) morphology increased through 1 year in preterm infants with bronchopulmonary dysplasia and/or pulmonary hypertension (p < 0.01). CONCLUSION Preterm infants exhibit abnormal right ventricle performance with remodelling at 32 weeks post-menstrual age that persists through 1 year corrected age, suggesting a less developed intrinsic myocardial function response following preterm birth. The development of bronchopulmonary dysplasia and pulmonary hypertension leave a further negative impact on right ventricle mechanics over the first year of age.
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Metabolic outcomes in very low birthweight and preterm infants in later life. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children. Cardiol Young 2019; 29:626-636. [PMID: 31159892 DOI: 10.1017/s1047951119000350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children. METHOD We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children's hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan-Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson's method. RESULTS Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92). CONCLUSION Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.
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Preterm Birth Is a Novel, Independent Risk Factor for Altered Cardiac Remodeling and Early Heart Failure: Is it Time for a New Cardiomyopathy? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:8. [PMID: 30762137 DOI: 10.1007/s11936-019-0712-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Around 10% of the global population is born preterm (< 37 weeks' gestation). Preterm birth is associated with an increased risk of cardiovascular events, with preterm-born individuals demonstrating a distinct cardiac phenotype. This review aims to summarize the main phenotypic features of the preterm heart and directions for future research to develop novel intervention strategies. RECENT FINDINGS Being born between 28 and 31 weeks' gestation results in a 4-fold higher risk of heart failure in childhood and adolescence and 17-fold increased risk when born less than 28 weeks' gestation. In support of this being due to a reduction in myocardial functional reserve, preterm-born young adults have an impaired left ventricular cardiac systolic response to moderate and high intensity physiological stress, despite having a preserved resting left ventricular ejection fraction. Similar impairments under physiological stress were also recently reported regarding the right ventricle in young adults born preterm. Preterm birth relates to a unique cardiac phenotype with an impaired response to stress conditions. These data, combined with the work in animal models, suggest that being born preterm may lead to a novel form of cardiomyopathy. Understanding the driving mechanisms leading to this unique cardiac phenotype is important to reduce risk of future heart failure and cardiovascular events.
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Affiliation(s)
- Adam J. Lewandowski
- 0000 0004 1936 8948grid.4991.5Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Agnew EJ, Ivy JR, Stock SJ, Chapman KE. Glucocorticoids, antenatal corticosteroid therapy and fetal heart maturation. J Mol Endocrinol 2018; 61:R61-R73. [PMID: 29720513 PMCID: PMC5976079 DOI: 10.1530/jme-18-0077] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 01/08/2023]
Abstract
Glucocorticoids are essential in mammals to mature fetal organs and tissues in order to survive after birth. Hence, antenatal glucocorticoid treatment (termed antenatal corticosteroid therapy) can be life-saving in preterm babies and is commonly used in women at risk of preterm birth. While the effects of glucocorticoids on lung maturation have been well described, the effects on the fetal heart remain less clear. Experiments in mice have shown that endogenous glucocorticoid action is required to mature the fetal heart. However, whether the potent synthetic glucocorticoids used in antenatal corticosteroid therapy have similar maturational effects on the fetal heart is less clear. Moreover, antenatal corticosteroid therapy may increase the risk of cardiovascular disease in adulthood. Here, we present a narrative review of the evidence relating to the effects of antenatal glucocorticoid action on the fetal heart and discuss the implications for antenatal corticosteroid therapy.
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Affiliation(s)
- Emma J Agnew
- University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - Jessica R Ivy
- University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - Sarah J Stock
- MRC Centre for Reproductive HealthUniversity of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - Karen E Chapman
- University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
- Correspondence should be addressed to K E Chapman:
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