The Preterm Heart in Adult Life: Cardiovascular Magnetic Resonance Reveals Distinct Differences in Left Ventricular Mass, Geometry and Function

Adam J. Lewandowski; Daniel Augustine; Pablo Lamata; Esther F. Davis; Merzaka Lazdam; Jane Francis; Kenny McCormick; Andrew Wilkinson; Atul Singhal; Alan Lucas; Nic Smith; Stefan Neubauer; Paul Leeson

CIRCULATIONAHA.112.126920 Published online before print December 5, 2012

Abstract

Background—Preterm birth leads to an early switch from fetal to postnatal circulation before completion of left ventricular in utero development. In animal studies this results in an adversely remodeled left ventricle. We determined whether preterm birth is associated with a distinct left ventricular structure and function in humans.

Methods and Results—234 individuals aged 20-39 years underwent cardiovascular magnetic resonance. 102 had been followed prospectively since preterm birth (gestational age = 30.3±2.5weeks and birthweight = 1.3±0.3kilograms) and 132 were born at term to uncomplicated pregnancies. Longitudinal and short-axis cine images were used to quantify: left ventricular mass, three-dimensional geometric variation by creation of a unique computational cardiac atlas, and myocardial function. We then determined whether perinatal factors modify these left ventricular parameters. Individuals born preterm had increased left ventricular mass (66.5±10.9 vs 55.4±11.4g/m2, P<0.001) with greater prematurity associated with greater mass (r=-0.22, P=0.03). Preterm-born individuals had short left ventricles with small internal diameters and a displaced apex. Ejection fraction was preserved (P>0.99) but both longitudinal systolic (peak strain, strain rate and velocity, P<0.001) and diastolic (peak strain rate and velocity, P<0.001) function, as well as rotational (apical and basal peak systolic rotation rate, P=0.05 and P=0.006, and net twist angle, P=0.02) movement, were significantly reduced. A diagnosis of preeclampsia during the pregnancy was associated with further reductions in longitudinal peak systolic strain in the offspring (P=0.02, n=29).

Conclusions—Individuals born preterm have increased left ventricular mass in adult life. Furthermore, they exhibit a unique three-dimensional left ventricular geometry as well as significant reductions in systolic and diastolic functional parameters.