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Association of Preterm Birth With Myocardial Fibrosis
Quick Takes
- Young adults born preterm have evidence of greater diffuse myocardial fibrosis in the LV that relates to the degree of prematurity.
- Preterm-born adults also exhibit LV structural/functional changes, including smaller LV end-diastolic and stroke volumes, greater mass, and lower systolic and diastolic function.
- Furthermore, impairments in diastolic function by both CMR and echocardiography relate to the greater diffuse myocardial fibrosis as well as the degree of prematurity.
Study Questions:
Do preterm-born adults have greater left ventricular (LV) myocardial fibrosis, and does this relate to the degree of prematurity and their known reductions in systolic and diastolic function?
Methods:
The investigators included 101 normotensive young adults born preterm (n = 47, mean gestational age 32.8 ± 3.2 weeks) and term (n = 54) from YACHT (Young Adult Cardiovascular Health sTudy). LV structure and function were quantified by cardiovascular magnetic resonance (CMR) and echocardiography. Intravenous administration of a gadolinium-based contrast agent during CMR was used to quantify focal myocardial fibrosis on the basis of late gadolinium enhancement and, in combination with T1 mapping, to quantify diffuse myocardial fibrosis on the basis of assessment of myocardial extracellular volume fraction. Group comparisons between the preterm-born and term-born adults were adjusted for sex to account for differing sex distributions between groups using multivariable linear regression, with adjusted mean differences and 95% confidence intervals (CIs) reported for the variables of interest.
Results:
Adults born preterm had smaller LV end-diastolic and stroke volumes, with greater LV mass and wall thickness (p < 0.001). In addition, longitudinal peak systolic strain and diastolic strain rate by both CMR and echocardiography, and E/A ratio measured by echocardiography, were lower in preterm-born compared to term-born adults (p < 0.05). Extracellular volume fraction was greater in preterm-born compared with term-born adults (27.81% ± 1.69% vs. 25.48% ± 1.41%; p < 0.001) and was a significant mediator in the relationship between gestational age and both longitudinal peak diastolic strain rate and E/A ratio.
Conclusions:
The authors concluded that preterm-born young adults have greater extracellular volume fraction in the left ventricle that is inversely related with gestational age and may underlie their diastolic functional impairments.
Perspective:
This study reports that young adults born preterm have evidence of greater diffuse myocardial fibrosis in the LV that relates to the degree of prematurity. Preterm-born adults also exhibit LV structural/functional changes, including smaller LV end-diastolic and stroke volumes, greater mass, and lower systolic and diastolic function. Furthermore, impairments in diastolic function by both CMR and echocardiography relate to the greater diffuse myocardial fibrosis as well as the degree of prematurity. Additional studies are indicated to assess whether myocardial fibrosis in young adults born preterm worsens with aging and after acquiring conventional cardiovascular risk factors.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Echocardiography/Ultrasound, Magnetic Resonance Imaging
Keywords: Contrast Media, Diastole, Diagnostic Imaging, Echocardiography, Fibrosis, Gadolinium, Heart Failure, Magnetic Resonance Imaging, Myocardium, Premature Birth, Risk Factors, Secondary Prevention, Stroke Volume, Systole, Young Adult
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