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

Abstract：

BACKGROUND: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. OBJECTIVES:The authors performed echocardiographic imaging at prescribed exercise intensities to determine whether preterm-born adults have impaired LV functional response to physical exercise. METHODS:We recruited 101 normotensive young adults born preterm (n = 47; mean gestational age 32.8 ± 3.2 weeks) and term (n = 54) 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. RESULTS: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). CONCLUSIONS: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).

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Huckstep OJ,Williamson W,Telles F,Burchert H,Bertagnolli M,Herdman C,Arnold L,Smillie R,Mohamed A,Boardman H,McCormick K,Neubauer S,Leeson P,Lewandowski AJ

doi

10.1016/j.jacc.2018.01.046

subject

Has Abstract

pub_date

2018-03-27 00:00:00

pages

1347-1356

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(18)30323-1

journal_volume

pub_type

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