Right Ventricular Structure and Function in Young Adults Born Preterm at Very Low Birth Weight

Being born preterm (PT, <37 weeks gestation) or at very low birth weight (VLBW, <1500 g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. In this population-based study, we aimed to investigate right heart structure and function in young adults born PT at VLBW compared to normal-weight term-born controls. The New Zealand VLBW Study has followed all infants born in 1986 with birth weight <1500 g. All were born preterm from 24 to 37 weeks. A total of 229 (71% of survivors) had echocardiograms aged 26–30 years which were compared to age-matched, term-born, normal-weight controls (n = 100). Young adults born preterm at very low birth weight exhibited smaller RV dimensions compared to term-born peers. Standard echocardiographic measures of RV function did not differ, but mildly reduced function was detected by RV longitudinal strain. This difference was related to birth weight and gestational age but not lung function or left ventricular function. Echocardiographic strain imaging may be an important tool to detect differences in RV function preterm and VLBW.

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Very low birth weight is associated with reduced right ventricular function detected by strain imaging in early adulthood – findings from a prospective matched cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0109 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Greer ◽

P Adamson ◽

S Harris ◽

J Horwood ◽

R Troughton ◽

...

Keyword(s):

Young Adults ◽

Birth Weight ◽

Low Birth Weight ◽

Right Ventricular ◽

Very Low Birth Weight ◽

Global Longitudinal Strain ◽

Strain Imaging ◽

Normal Weight ◽

Free Wall ◽

Rv Function

Abstract Introduction Being born at very low birth weight (VLBW, <1500g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. Strain imaging provides prognostically important information regarding RV dysfunction in diverse cardiopulmonary conditions however, these indices have not previously been described within VLBW cohorts. Purpose To assess differences in right heart function using strain in young adults born at VLBW, compared to normal weight term born controls. Methods The New Zealand Very Low Birth Weight Study has followed all infants born in 1986 with birth weight <1500g. Of 323 survivors to adulthood, 228 (71%) had echocardiograms at 26–30 years which were compared to age and sex-matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured by speckle tracking echocardiography by an investigator blinded to group allocation. Established measures of RV function (fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities) were also obtained. Results VLBW subjects were smaller than their peers as young adults (Table 1). Strain measurement showed reduced myocardial deformation among VLBW subjects (RV myocardial GLS: −22.4% vs −23.5%, p=0.008; RV endocardial GLS: −23.6% vs −24.9%, p=0.005; free wall myocardial GLS −25.2% vs −26.1%, p=0.039; free wall endocardial GLS −26.7% vs −27.9%, p=0.009). TR velocity was higher in VLBW: 224 cm/s v 210 cm/s (p=0.002). RV S', and FAC were not different. Conclusion Young adults born at VLBW have impaired myocardial strain despite preserved RV function as assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction. Graph 1 Funding Acknowledgement Type of funding source: None

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Low birth weight predicts impaired cardiac structure and function in mid-adulthood

European Heart Journal ◽

10.1093/eurheartj/ehab724.099 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Q Huynh ◽

C Magnussen ◽

A Venn ◽

T Marwick

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Left Ventricular ◽

Structure And Function ◽

Volume Index ◽

Cardiac Structure ◽

Weight Category ◽

Causal Pathways ◽

Cardiac Structure And Function ◽

And Function

Abstract Aims We sought to determine the relationship of low birth weight (LBW) with adult cardiac structure and function and investigate potential causal pathways. Methods We followed 925 Australians (41.3% male) from childhood (7–15 years) to young- (26–36 years) and mid-adulthood (36–50 years). Left ventricular (LV) global longitudinal strain (GLS, %), LV mass index (LVMi, g/m2.7), LV filling pressure (E/e') and left atrial volume index (LAVi, g/m2) were measured by echocardiography in mid-adulthood. Birth weight category was self-reported in adulthood and classified as low (≤5 pounds or ≤2270 g), normal (5–8 pounds or 2271–3630 g) and high (>8 pounds or >3630 g). Results 7.5% (69/925) reported LBW. Compared with participants with normal birth weight, those with LBW had a 2.01-fold (1.19–3.41, p=0.009) higher risk of impaired GLS (GLS >−18%) and 2.63-fold (0.89–7.81, p=0.08) higher risk of LV hypertrophy (LVMi >48 g/m2.7 in men or >44 g/m2.7 in women) in adulthood independent of age, sex and any measures of socioeconomic status. Participants with LBW significantly increased body fat from childhood to adulthood relative to their peers, which was associated with greater levels of triglycerides, fasting blood glucose and arterial stiffness in adulthood. These factors were the strongest mediators in the association of LBW with impaired GLS in adulthood and together, explained half of the LBW effect size. The remaining half of this association was independent of any measured factors. Conclusions LBW was associated with impaired cardiac structure and function in mid-adulthood. This association was only partially explained by known risk factors. FUNDunding Acknowledgement Type of funding sources: None.

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Faculty Opinions recommendation of Ambulatory blood pressure in young adults with very low birth weight.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2036974.1615075 ◽

2010 ◽

Author(s):

Eero Jokinen ◽

Tiina Ojala

Keyword(s):

Blood Pressure ◽

Young Adults ◽

Birth Weight ◽

Low Birth Weight ◽

Ambulatory Blood Pressure ◽

Very Low Birth Weight

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A cross-sectional study of glucose regulation in young adults with very low birth weight: impact of male gender on hyperglycaemia

BMJ Open ◽

10.1136/bmjopen-2011-000327 ◽

2012 ◽

Vol 2 (1) ◽

pp. e000327 ◽

Cited By ~ 9

Author(s):

Ryosuke Sato ◽

Hiroshi Watanabe ◽

Kenji Shirai ◽

Shigeru Ohki ◽

Rieko Genma ◽

...

Keyword(s):

Young Adults ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Cross Sectional Study ◽

Male Gender ◽

Glucose Regulation ◽

Sectional Study ◽

Cross Sectional ◽

Weight Impact

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Diet and Nutrient Intake in Young Adults Born Preterm at Very Low Birth Weight

The Journal of Pediatrics ◽

10.1016/j.jpeds.2012.12.076 ◽

2013 ◽

Vol 163 (1) ◽

pp. 43-48 ◽

Cited By ~ 33

Author(s):

Nina Kaseva ◽

Karoliina Wehkalampi ◽

Katri Hemiö ◽

Petteri Hovi ◽

Anna-Liisa Järvenpää ◽

...

Keyword(s):

Young Adults ◽

Birth Weight ◽

Low Birth Weight ◽

Nutrient Intake ◽

Very Low Birth Weight

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Neonatal Nutrition Predicts Energy Balance in Young Adults Born Preterm at Very Low Birth Weight

Nutrients ◽

10.3390/nu9121282 ◽

2017 ◽

Vol 9 (12) ◽

pp. 1282 ◽

Cited By ~ 2

Author(s):

Hanna-Maria Matinolli ◽

Petteri Hovi ◽

Esko Levälahti ◽

Nina Kaseva ◽

Patricia Silveira ◽

...

Keyword(s):

Young Adults ◽

Birth Weight ◽

Energy Balance ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Neonatal Nutrition

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Effect of Hypocalcemia on Cardiac Function in Very-Low-Birth-Weight Preterm Neonates: Studies of Blood Ionized Calcium, Echocardiography, and Cardiac Effect of Intravenous Calcium Therapy

PEDIATRICS ◽

10.1542/peds.76.4.543 ◽

1985 ◽

Vol 76 (4) ◽

pp. 543-550

Author(s):

Pankaja S. Venkataraman ◽

Don A. Wilson ◽

Roger E. Sheldon ◽

Radhakrishna Rao ◽

Michael K. Parker

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Cardiac Function ◽

Serum Calcium ◽

Calcium Concentration ◽

Very Low Birth Weight ◽

Left Ventricular ◽

Ionized Calcium ◽

Total Calcium ◽

Serum Total Calcium

Traditionally, in infants, a serum calcium value less than 7.0 mg/dL is considered to impair cardiac function. In very-low-birth-weight infants, we studied the hypotheses that decline in serum calcium to 6.0 mg/dL (1) would not impair cardiac function and (2) ionized calcium would remain greater than 3.0 mg/dL. We also evaluated the effect of calcium infusion on cardiac function. We studied 15 normokalemic and normonatremic infants whose birth weights were 822 to 1,450 g and were less than 32 weeks' gestation. When serum calcium declined to less than 6.0 mg/dL, 18 mg/kg of calcium as 5% calcium gluconate was infused for 10 minutes. Serum total calcium concentration, blood ionized calcium concentration, ECG, and M-mode echocardiogram were obtained on entry into the study, when the infants were hypocalcemic, immediately after treatment with calcium, and eight hours after treatment. Ionized calcium values were calculated based on serum total calcium and serum protein, and corrected calcium values were calculated based on serum total calcium, serum albumin, and blood pH. In all infants, serum calcium value declined to less than 7.0 and in eight infants to less than 6.0 mg/dL. Assessment of heart rate, systolic blood pressure, ejection fraction, left ventricular systolic time interval, right ventricular systolic time interval, fiber shortening index, and left ventricular mean velocity of circumferential fiber shortening showed no significant alteration from baseline during hypocalcemia or in association with intravenous slow bolus infusion of 18 mg/kg of calcium. In association with a decline in serum total calcium to as low as 6.0 mg/dL, whole blood ionized calcium was maintained at more than 3.0 mg/dL. Serum total calcium and calculated ionized calcium values correlated significantly with measured blood ionized calcium concentrations; however, these measures were not reliable predictors of blood ionized calcium. We speculate that the hypoproteinemia and hypoalbuminemia noted in these infants may result in relative protection of the blood ionized calcium in these infants. We suggest that in neonates with wide ranges in gestation, serum protein, and blood pH levels, total serum calcium and calculated ionized calcium values may be poor measures of derangement of calcium metabolism. Decline in total serum calcium concentration to 6.0 mg/dL was not associated with impaired cardiac function, and slow bolus calcium infusion in these hypocalcemic very-low-birth-weight infants neither improved nor impaired cardiac function.

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Cardiac Effects of Dexamethasone in Very Low Birth Weight Infants

PEDIATRICS ◽

10.1542/peds.97.6.818 ◽

1996 ◽

Vol 97 (6) ◽

pp. 818-821 ◽

Cited By ~ 2

Author(s):

Andrew S. Bensky ◽

Jamanadas M. Kothadia ◽

Wesley Covitz

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Wall Thickness ◽

Very Low Birth Weight ◽

Systolic Function ◽

Left Ventricular ◽

Low Birth Weight Infants ◽

Cardiac Effects ◽

Significant Prolongation ◽

Lv Mass

Objective. To characterize the cardiac effects of dexamethasone in very low birth weight infants. Design. Prospective, randomized, placebo-controlled, double-blind trial. Enrolled subjects were randomized to receive either a 42-day tapering course of dexamethasone or a saline placebo. Echocardiographic measurements were obtained on days 0, 7, 14, 28, and 42. Subjects. Thirteen infants received dexamethasone and 13 a saline placebo. The two groups were similar in birth weight, gestational age, age at enrollment, and sex/race composition. Results. Patients receiving dexamethasone had a significantly larger increase in septal thickness on days 7, 14, and 28 and left ventricle (LV) posterior wall thickness on day 14. A significantly lower left ventricular enddiastolic dimension in the dexamethasone group was initially noted on day 7 and persisted until day 42. With the reduced left ventricular end-diastolic dimension, no significant differences in LV mass were noted, despite the increased wall thickness. No differences in LV systolic function, as assessed by area shortening, were seen. Assessment of diastolic function showed a significant increase in the atrial portion of mitral inflow in dexamethasone patients on day 14, as well as a significant prolongation in isovolumic relaxation time on days 7, 14, and 28. Conclusions. Infants receiving dexamethasone developed evidence for impaired LV filling with a larger increase in wall thickness but no increase in LV mass, asymmetric septal hypertrophy, or augmented systolic function. This suggests that alterations in left ventricular filling play an important role in the development of hypertrophy seen with dexamethasone administration.

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