Adults born preterm had significantly lower left ventricular end-diastolic volume index compared to term-born adults (MD -7.6 mL/m²; 95% CI -9.0 to -6.2; p<0.001), but preserved ejection fraction.
Meta-Analysis (n=1,243)
Does preterm birth alter left ventricular structure and function in adulthood compared to term birth?
Adults born preterm have significantly smaller left ventricular volumes but preserved ejection fraction compared to those born at term.
Effect estimate: MD -7.6 (95% CI -9.0 to -6.2)
p-value: p=< 0.001
Abstract Rationale Advancements in neonatal care have significantly improved survival rates, enabling many individuals born preterm to reach adulthood. The long-term implications of disrupted cardiovascular and pulmonary development remain of high interest. Most studies to date have small cohorts that are not equally characterized. To address this gap, we performed a systematic review and meta-analysis combining published cohort studies from 2020 to 2025 that reported cardiovascular outcomes of formerly preterm and term adults. Methods PubMed and Scopus were searched through October 2025 using phrases related to preterm birth, adulthood, and left ventricular imaging. The preliminary search yielded 112 results of which seven publications reported enrolling a mean age of 18 years or older born preterm (37 weeks), had a term born control group, and provided cardiac magnetic resonance imaging or echocardiography measures including left ventricular end diastolic volume index (LVEDVi), left ventricular mass index (LVMi), and ejection fraction (EF). Statistical analysis was conducted using R software to calculate mean differences and 95% confidence intervals using fixed and random effects models. Results Seven studies were included. Preterm (n = 686) and term (n = 557) mean age (years) were 22.6±3.5 and 23.7±4.2, and male (%) was 42±7 and 44±3, respectively. Mean differences (MD) showed that pooled LVEDVi was significantly lower in adults born preterm (MD: −7.6 mL/m², 95 % CI − 9.0 to − 6.2; p 0.001; I² 30 %). EF did not differ between groups (MD: 0.1 %, 95 % CI − 1.0 to 1.2; p = 0.86; I² ≈ 70 %). LVMi showed wide variation across cohorts (MD: −3.2 g/m², 95 % CI − 9.6 to 3.2; p = 0.32; I² 75 %). Conclusions Adults born preterm had small left ventricular volumes, but preserved ejection fraction, suggesting that despite reduced chamber size or diastolic filling, function remained intact. The variations in LVMi across cohorts may be due to differences in ventricular geometry and remodeling, which may be influenced by multiple factors including intrinsic cardiopulmonary phenotypic variability (such as biologic sex, post-preterm architectural lung distortion and systemic blood pressure) and extrinsic factors such as such as smoking history and socioeconomic background. This meta-analysis confirms differences in left ventricle structure in preterm vs. term adults and highlights a need for large cohort studies incorporating functional imaging and comprehensive clinical phenotyping to clarify the consequences of preterm birth across the life course. This abstract is funded by: None
Ahmed et al. (2026) conducted a meta-analysis in Adults born preterm (n=1,243). Preterm birth vs. Term birth was evaluated on Left ventricular end diastolic volume index (LVEDVi) (MD -7.6, 95% CI -9.0 to -6.2, p=< 0.001). Adults born preterm had significantly lower left ventricular end-diastolic volume index compared to term-born adults (MD -7.6 mL/m²; 95% CI -9.0 to -6.2; p<0.001), but preserved ejection fraction.