Right ventricular systolic dysfunction in young adults born preterm.
BACKGROUND
Young adults born preterm have distinct differences in left ventricular mass, function, and geometry. Animal studies suggest that cardiomyocyte changes are evident in both ventricles after preterm birth; therefore, we investigated whether these young adults also have differences in their right ventricular structure and function.


RESULTS
We studied 102 preterm-born young adults followed up prospectively since birth and 132 term-born control subjects born to uncomplicated pregnancies. We quantified right ventricular structure and function by cardiovascular magnetic resonance on a 1.5-T Siemens scanner using Argus and TomTec postprocessing software. Preterm birth was associated with a small right ventricle (end diastolic volume, 79.8±13.2 versus 88.5±11.8 mL/m(2); P<0.001) but greater right ventricular mass (24.5±3.5 versus 20.4±3.4 g/m2; P<0.001) compared with term-born controls, with the severity of differences proportional to gestational age (r=-0.47, P<0.001). Differences in right ventricular mass and function were proportionally greater than previously reported for the left ventricle. This was most apparent for systolic function; young adults born preterm had significantly lower right ventricular ejection fraction (57±8% versus 60±5%; P=0.006). Indeed, 21% had values below the lower limit observed in the term-born adults and 6% had mild systolic dysfunction (<45%). Postnatal ventilation accounted for some of the variation in mass but not function.


CONCLUSIONS
Preterm birth is associated with global myocardial structural and functional differences in adult life, including smaller right ventricular size and greater mass. The changes are greater in the right ventricle than previously observed in the left ventricle, with potentially clinically significant impairment in right ventricular systolic function.
Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX39DU, UK.
Adam J
AJ
Lewandowski
William M
WM
Bradlow
Daniel
D
Augustine
Esther F
EF
Davis
Jane
J
Francis
Atul
A
Singhal
Alan
A
Lucas
Stefan
S
Neubauer
Kenny
K
McCormick
Paul
P
Leeson
D000328:Adult; D000886:Anthropometry; D001724:Birth Weight; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000503:physiopathology*; D008019:Life Style; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D016037:Single-Blind Method; D013318:Stroke Volume; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*; D020257:Ventricular Remodeling / Q000502:physiology; D055815:Young Adult
heart; heart ventricles; magnetic resonance imaging; premature birth; systole; ventricular remodeling