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Defining the Heart of Young Adults Born Preterm: Cardiovascular Magnetic Resonance and Computational Atlas Formation Reveal Distinct Differences in Mass, Geometry, and Function

Presented at the Neonatal Society 2013 Autumn Meeting.

Lewandowski AJ1,2, Augustine D1,2, Bradlow WM3, Lamata P4,5, Davis EF1, Wilkinson AR6, Singhal A7, Lucas A7, Smith N5, Neubauer S2, McCormick K6, Leeson P1,2

1 Oxford Cardiovascular Clinical Research Facility, University of Oxford
2 Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, University of Oxford
3 Queen Elizabeth Hospital, Birmingham
4 Department of Computer Science, University of Oxford
5 Department of Biomedical Engineering, King’s College London
6 Department of Paediatrics, John Radcliffe Hospital, Oxford
7 MRC Childhood Nutrition Research Centre, Institute of Child Health, University College London. 

Background: Preterm birth leads to an early switch from fetal to postnatal circulation before completion of cardiac in utero development. We developed and applied novel cardiovascular magnetic resonance post-processing tools to determine whether preterm birth is associated with distinct changes in both cardiac structure and function in young adulthood (1,2).

Methods: 234 individuals aged 20-39 years underwent cardiovascular magnetic resonance on a 1.5T Siemens Sonata scanner. 102 had been followed prospectively since preterm birth (gestational age=30.3±2.5weeks and birthweight=1.30±0.29kilograms) and 132 were born at term to uncomplicated pregnancies. Left ventricular (LV) and right ventricular (RV) mass, volumes, and dimensions were quantified using Argus and novel computational atlas methods, and LV and RV function were quantified using TomTec 2D Cardiac Performance Analysis MR.

Results: Individuals born preterm had increased LV and RV mass and reduced LV and RV end-diastolic volumes (EDV) compared to term-born young adults (LV and RV mass: P<0.001; LV and RV EDV: P<0.001) and term-born adults a decade older (LV and RV mass: P<0.001; LV EDV: P<0.001; RV EDV: P=0.01). Differences in right ventricular mass and function were proportionally greater than for the left ventricle, which was most apparent for systolic function. Ejection fraction (EF) was preserved for the left ventricle but reduced for the right ventricle compared to the term-born young adults (LVEF: P>0.99; RVEF: P=0.006) and the term-born adults a decade older (LVEF: P>0.99; RVEF: P=0.04). Both LV and RV longitudinal peak systolic strain and peak systolic strain rate were reduced in the preterm-born young adults compared to the term-born young adults and adults a decade older (P<0.01). Furthermore, LV and RV longitudinal peak diastolic strain rate were reduced compared to the term-born young adults (P<0.01) but not the older term-born adults (P>0.10).

Conclusion: We have demonstrated for the first time that individuals born preterm have unique differences in cardiac geometry and function. A better understanding of the mechanisms underlying these changes in structure and function will be used to determine possible pathways to prevent future cardiac complications of preterm birth.

Corresponding author: adam.lewandowski@cardiov.ox.ac.uk

References
1. Lewandowski AJ et al. Preterm heart in adult life: cardiovascular magnetic resonance reveals distinct differences in left ventricular mass, geometry and function. Circulation 2013;127(2):197-206.
2. Lewandowski AJ et al. Right ventricular systolic dysfunction in young adults born preterm. Circulation 2013;128(7):713-20

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