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B Postnatal Cardiac Remodelling after Preterm Birth: Why Preterm-Born Individuals have a Unique Functional and Structural Phenotype in Young Adulthood?
  1. Adam Lewandowski1,
  2. Christina Aye2,
  3. Pablo Lamata3,
  4. Ross Upton2,
  5. Stefan Neubauer2,
  6. Paul Leeson2
  1. 1Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford Cardiovascular Clinical Research Facility, Level 1, John Radcliffe Hospital, Oxford OX39DU
  2. 2Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford
  3. 3Department of Biomedical Engineering, King’s College of London

Abstract

Background Preterm birth leads to a switch from fetal to postnatal circulation before completion of in utero cardiac development. We hypothesised that those born preterm would have a unique adult cardiac phenotype and that this would develop during postnatal life.

Methods 234 young adults underwent cardiovascular magnetic resonance, of which 102 had been followed prospectively since preterm birth. We then studied 200 infants, longitudinally from birth to three months of age using echocardiography, of which 111 were born preterm. To define cardiac shape and function in adult and neonatal life we developed in-house 3D computational approaches and applied novel deformation imaging tools.

Results born preterm had increased LV and RV mass index (P < 0.001 and P < 0.001), proportional to severity of prematurity (P = 0.03 and P < 0.001), and reduced chamber volumes and length (P < 0.01). Although LV ejection fraction was preserved, RV ejection fraction was reduced (P = 0.006), as were LV systolic and diastolic myocardial deformation. At birth, preterm-born infants had similar LV mass index, appropriate for gestational body size, as term-born infants (P = 0.13). However, by three months a greater percentage increase (P = 0.01) resulted in significantly greater LV mass index in those born preterm (P = 0.04). Interestingly, their LV end-diastolic volume index was already smaller at birth (P = 0.003) and this difference persisted at three months (P = 0.05).

Conclusions Birth is associated with a unique adult cardiac phenotype. Disproportionate increases in mass occur during postnatal life alongside persistent shape changes. Postnatal life may be a critical window for modification of cardiac development, relevant to the adult cardiovasculature.

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