Physiological Stress Elicits Impaired Left Ventricular Function in Preterm-Born Adults

• Published in: Journal of the American College of Cardiology Vol. 71; no. 12; pp. 1347 - 1356
• Main Authors: Huckstep, Odaro J., Williamson, Wilby, Telles, Fernando, Burchert, Holger, Bertagnolli, Mariane, Herdman, Charlotte, Arnold, Linda, Smillie, Robert, Mohamed, Afifah, Boardman, Henry, McCormick, Kenny, Neubauer, Stefan, Leeson, Paul, Lewandowski, Adam J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 27-03-2018; Elsevier Limited; Elsevier Biomedical
• Subjects: Adolescent; Adult; Adults; Biochemistry; Blood pressure; cardiac function; Cardiac output; Cardiology; Case-Control Studies; Echocardiography; Echocardiography - methods; ejection fraction; Epidemiology; Exercise Test - methods; Female; Gestational age; Heart; Heart diseases; Heart failure; Humans; Hypertension; Infant, Premature - physiology; Male; myocardial reserve; Phenotyping; Physical exercise; Physiology; premature; Premature birth; preterm; Strain; Stress; Stress (physiology); Stress, Physiological - physiology; Stresses; Structure-function relationships; Studies; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Young Adult; Young adults; heart failure; EF; CPET; ejection fraction; CI; echocardiography; COR; preterm; CMR; ESV; LV; myocardial reserve; BSA; premature; EDV; cardiac function
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2018.01.046

Experimental and clinical studies show that prematurity leads to altered left ventricular (LV) structure and function with preserved resting LV ejection fraction (EF). Large-scale epidemiological data now links prematurity to increased early heart failure risk.
Echocardiography imaging was performed at prescribed exercise intensities to determine whether preterm-born adults have impaired LV functional response to physical exercise.
A total of 101 normotensive young adults born preterm (n = 47; mean gestational age 32.8 ± 3.2 weeks) and term (n = 54) were recruited for detailed cardiovascular phenotyping. Full clinical resting and exercise stress echocardiograms were performed, with apical 4-chamber views collected while exercising at 40%, 60%, and 80% of peak exercise capacity, determined by maximal cardiopulmonary exercise testing.
Preterm-born individuals had greater LV mass (p = 0.015) with lower peak systolic longitudinal strain (p = 0.038) and similar EF to term-born control subjects at rest (p = 0.62). However, by 60% exercise intensity, EF was 6.7% lower in preterm subjects (71.9 ± 8.7% vs 78.6 ± 5.4%; p = 0.004) and further declined to 7.3% below the term-born group at 80% exercise intensity (69.8 ± 6.4% vs 77.1 ± 6.3%; p = 0.004). Submaximal cardiac output reserve was 56% lower in preterm-born subjects versus term-born control subjects at 40% of peak exercise capacity (729 ± 1,162 ml/min/m2 vs. 1,669 ± 937 ml/min/m2; p = 0.021). LV length and resting peak systolic longitudinal strain predicted EF increase from rest to 60% exercise intensity in the preterm group (r = 0.68, p = 0.009 and r = 0.56, p = 0.031, respectively).
Preterm-born young adults had impaired LV response to physiological stress when subjected to physical exercise, which suggested a reduced myocardial functional reserve that might help explain their increased risk of early heart failure. (Young Adult Cardiovascular Health sTudy [YACHT]; NCT02103231)
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