Key result
Extreme preterm birth was associated with higher central systolic blood pressure at age 18 (111 vs. 105 mmHg; P<0.001) and elevated aortic wave reflection indices compared to term-born controls.
Why the study?
Does extremely preterm birth affect aortic wave reflection and central blood pressure in adolescence?
Cohort (n=118)
Does extremely preterm birth affect aortic wave reflection and central blood pressure in adolescence?
Absolute Event Rate: 111% vs 105%
p-value: p=<0.001
Ex-preterm adolescents exhibit elevated aortic wave reflection indices that correlate with higher central systolic blood pressure, suggesting wave intensity analysis as a marker for evolving vascular dysfunction.
Should not yet alter surveillance in ex-preterm youth; leaves open whether wave reflection predicts later events.
OBJECTIVE: To evaluate the wave reflection characteristics in the aortic arch and common carotid artery of ex-preterm adolescents and assess their relationship to central blood pressure in a cohort followed prospectively since birth. METHODS: Central blood pressures, pulse wave velocity, augmentation index, microvascular reactive hyperemia, arterial distensibility, compliance and stiffness index, and also aortic and carotid wave intensity were measured in 18-year-olds born extremely preterm at below 28 weeks' gestation (n = 76) and term-born controls (n = 42). RESULTS: Compared with controls, ex-preterm adolescents had higher central systolic (111 ± 11 vs. 105 ± 10 mmHg; P < 0.001) and diastolic blood pressures (73 ± 7 vs. 67 ± 7 mmHg; P < 0.001). Although conventional measures of arterial function and biomechanics such as pulse wave velocity and augmentation index were no different between groups, wave intensity analysis revealed elevated backward compression wave area (-0.39 ± 0.21 vs. -0.29 ± 0.17 W/m/s × 10; P = 0.03), backward compression wave pressure change (9.0 ± 3.5 vs. 6.6 ± 2.5 mmHg; P = 0.001) and reflection index (0.44 ± 0.15 vs. 0.32 ± 0.08; P < 0.001) in the aorta of ex-preterm adolescents compared with controls. These changes were less pronounced in the carotid artery. On multivariable analysis, forward and backward compression wave areas were the only biomechanical variables associated with central systolic pressure. CONCLUSIONS: Ex-preterm adolescents demonstrate elevated wave reflection indices in the aortic arch, which correlate with central systolic pressure. Wave intensity analysis may provide a sensitive novel marker of evolving vascular dysfunction in ex-preterm survivors.
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Kowalski et al. (2018) conducted a cohort in Ex-preterm adolescents (n=118). Extreme preterm birth (<28 weeks' gestation) vs. Term birth was evaluated on Central systolic blood pressure (mmHg) (p=<0.001). Extreme preterm birth was associated with higher central systolic blood pressure at age 18 (111 vs. 105 mmHg; P<0.001) and elevated aortic wave reflection indices compared to term-born controls.
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