Key result
Preterm birth in young adults linked to ~2.3% greater LV ECV, indicating diffuse myocardial fibrosis.
Why the study?
Preterm birth is associated with cardiac alterations, and animal models suggest left ventricular impairment may stem from myocardial fibrosis, but whether diffuse fibrosis occurs in young adults born preterm was unknown.
Does preterm birth increase myocardial fibrosis and diastolic dysfunction in young adulthood compared to term birth?
Observational (n=101)
Does preterm birth increase myocardial fibrosis and diastolic dysfunction in young adulthood compared to term birth?
Young adults born preterm exhibit greater diffuse left ventricular fibrosis and diastolic functional impairments compared to those born at term.
Preterm birth associated with greater LV fibrosis in young adulthood; hypothesis-generating and requires prospective confirmation.
BACKGROUND: Preterm birth affects about 10% of live births worldwide and is associated with cardiac alterations. Animal models of preterm birth suggest that left ventricular functional impairment may be due to an up-regulation of myocardial fibrosis. OBJECTIVES: The aim of this study was to determine whether diffuse left ventricular fibrosis is evident in young adults born preterm. METHODS: One hundred one normotensive young adults born preterm (n = 47, mean gestational age 32.8 ± 3.2 weeks) and term (n = 54) were included from YACHT (Young Adult Cardiovascular Health sTudy). Left ventricular structure and function were quantified by cardiovascular magnetic resonance and echocardiography. Intravenous administration of a gadolinium-based contrast agent during cardiovascular magnetic resonance 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. RESULTS: Adults born preterm had smaller left ventricular end-diastolic and stroke volumes, with greater left ventricular mass and wall thickness (P < 0.001). In addition, longitudinal peak systolic strain and diastolic strain rate by both cardiovascular magnetic resonance 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: 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.
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Lewandowski et al. (2021) conducted an observational in Preterm birth (n=101). Preterm birth vs. Term birth was evaluated on Myocardial extracellular volume fraction (diffuse myocardial fibrosis) (p=<0.001). Young adults born preterm had significantly greater left ventricular extracellular volume fraction compared to those born at term (27.81% vs 25.48%; P<0.001), indicating diffuse myocardial fibrosis.
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