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Original Investigation
May 20, 2020

Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults

Author Affiliations
  • 1Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison
  • 2Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
  • 3Department of Kinesiology, School of Medicine and Public Health, University of Wisconsin–Madison
  • 4Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin–Madison
  • 5Department of Orthopedic and Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
  • 6Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
  • 7Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin–Madison
  • 8Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin–Madison
  • 9Department of Radiology, School of Medicine and Public Health, University of Wisconsin–Madison
JAMA Cardiol. Published online May 20, 2020. doi:10.1001/jamacardio.2020.1511
Key Points

Question  What are the consequences of premature birth for later cardiac structure and function?

Findings  In this cardiac magnetic resonance imaging–based cross-sectional cohort study, adolescents (n = 20) and young adults (n = 38) born moderately to extremely preterm (≤32 weeks) demonstrated statistically significantly smaller biventricular cardiac chamber size and lower biventricular mass compared with 52 age-matched participants who were born at term. Cardiac function was preserved, with a hypercontractile strain pattern in adults.

Meaning  Adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size with preserved function, notably without a hypertrophic response, which may contribute to their increased lifetime cardiovascular risk.

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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