TY - JOUR
T1 - Association between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults
AU - Goss, Kara N.
AU - Haraldsdottir, Kristin
AU - Beshish, Arij G.
AU - Barton, Gregory P.
AU - Watson, Andrew M.
AU - Palta, Mari
AU - Chesler, Naomi C.
AU - Francois, Chris J.
AU - Wieben, Oliver
AU - Eldridge, Marlowe W.
N1 - Funding Information:
This study was funded by grants 1R01 HL086897 and R01 HL38149 from the NIH (Dr Eldridge). Dr Goss is supported by the University of Wisconsin Clinical and Translational Science Award Program through the NIH National Center for Advancing Translational Sciences, by grant UL1TR000427 from the NIH (primary investigator, Marc Drezner; subaward 4KL2TR000428-10), and by a Parker B. Francis Fellowship award and American Heart Association Career Development Award (grant 18CDA34110440). Assembly of the Newborn Lung Cohort was supported by grant R01 HL38149 from the NIH (Dr Palta).*%blankline%*
Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/8
Y1 - 2020/8
N2 - 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/m2for 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..
AB - 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/m2for 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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U2 - 10.1001/jamacardio.2020.1511
DO - 10.1001/jamacardio.2020.1511
M3 - Article
C2 - 32432648
AN - SCOPUS:85085328373
SN - 2380-6583
VL - 5
SP - 910
EP - 919
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 8
ER -