TY - JOUR
T1 - Changes in the Preterm Heart from Birth to Young Adulthood
T2 - A Meta-analysis
AU - Telles, Fernando
AU - McNamara, Nicholas
AU - Nanayakkara, Shane
AU - Doyle, Mathew P.
AU - Williams, Michael
AU - Yaeger, Lauren
AU - Marwick, Thomas H.
AU - Leeson, Paul
AU - Levy, Philip T.
AU - Lewandowski, Adam J.
N1 - Funding Information:
FUNDING: Dr Lewandowski is funded by a British Heart Foundation Intermediate Research Fellowship (FS/18/3/33292). Funders were not involved in the design or conduct of the meta-analysis; the collection, management, or interpretation of the data; or the preparation, review, or approval of the article.
Publisher Copyright:
© 2020 American Academy of Pediatrics. All rights reserved.
PY - 2020/8
Y1 - 2020/8
N2 - CONTEXT: Preterm birth is associated with incident heart failure in children and young adults. OBJECTIVE: To determine the effect size of preterm birth on cardiac remodeling from birth to young adulthood. DATA SOURCES: Data sources include Medline, Embase, Scopus, Cochrane databases, and clinical trial registries (inception to March 25, 2020). STUDY SELECTION: Studies in which cardiac phenotype was compared between preterm individuals born at ,37 weeks’ gestation and age-matched term controls were included. DATA EXTRACTION: Random-effects models were used to calculate weighted mean differences with corresponding 95% confidence intervals. RESULTS: Thirty-two observational studies were included (preterm = 1471; term = 1665). All measures of left ventricular (LV) and right ventricular (RV) systolic function were lower in preterm neonates, including LV ejection fraction (P = .01). Preterm LV ejection fraction was similar from infancy, although LV stroke volume index was lower in young adulthood. Preterm LV peak early diastolic tissue velocity was lower throughout development, although preterm diastolic function worsened with higher estimated filling pressures from infancy. RV longitudinal strain was lower in preterm-born individuals of all ages, proportional to the degree of prematurity (R2 = 0.64; P = .002). Preterm-born individuals had persistently smaller LV internal dimensions, lower indexed LV end-diastolic volume in young adulthood, and an increase in indexed LV mass, compared with controls, of 0.71 g/m2 per year from childhood (P = .007). LIMITATIONS: The influence of preterm-related complications on cardiac phenotype could not be fully explored. CONCLUSIONS: Preterm-born individuals have morphologic and functional cardiac impairments across developmental stages. These changes may make the preterm heart more vulnerable to secondary insults, potentially underlying their increased risk of early heart failure.
AB - CONTEXT: Preterm birth is associated with incident heart failure in children and young adults. OBJECTIVE: To determine the effect size of preterm birth on cardiac remodeling from birth to young adulthood. DATA SOURCES: Data sources include Medline, Embase, Scopus, Cochrane databases, and clinical trial registries (inception to March 25, 2020). STUDY SELECTION: Studies in which cardiac phenotype was compared between preterm individuals born at ,37 weeks’ gestation and age-matched term controls were included. DATA EXTRACTION: Random-effects models were used to calculate weighted mean differences with corresponding 95% confidence intervals. RESULTS: Thirty-two observational studies were included (preterm = 1471; term = 1665). All measures of left ventricular (LV) and right ventricular (RV) systolic function were lower in preterm neonates, including LV ejection fraction (P = .01). Preterm LV ejection fraction was similar from infancy, although LV stroke volume index was lower in young adulthood. Preterm LV peak early diastolic tissue velocity was lower throughout development, although preterm diastolic function worsened with higher estimated filling pressures from infancy. RV longitudinal strain was lower in preterm-born individuals of all ages, proportional to the degree of prematurity (R2 = 0.64; P = .002). Preterm-born individuals had persistently smaller LV internal dimensions, lower indexed LV end-diastolic volume in young adulthood, and an increase in indexed LV mass, compared with controls, of 0.71 g/m2 per year from childhood (P = .007). LIMITATIONS: The influence of preterm-related complications on cardiac phenotype could not be fully explored. CONCLUSIONS: Preterm-born individuals have morphologic and functional cardiac impairments across developmental stages. These changes may make the preterm heart more vulnerable to secondary insults, potentially underlying their increased risk of early heart failure.
UR - http://www.scopus.com/inward/record.url?scp=85089129045&partnerID=8YFLogxK
U2 - 10.1542/peds.2020-0146
DO - 10.1542/peds.2020-0146
M3 - Review Article
C2 - 32636236
AN - SCOPUS:85089129045
SN - 0031-4005
VL - 146
JO - Pediatrics
JF - Pediatrics
IS - 2
M1 - e20200146
ER -