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Persistence of right ventricular dysfunction and altered morphometry in asymptomatic preterm Infants through one year of age: Cardiac phenotype of prematurity

Published online by Cambridge University Press:  09 July 2019

Collin T. Erickson ,
Meghna D. Patel ,
Swati Choudhry ,
Karl Stessy Bisselou ,
Tim Sekarski ,
Mary Craft ,
Ling Li ,
Afif El Khuffash ,
Aaron Hamvas  and
Shelby Kutty
...Show all authors
Collin T. Erickson
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, NE, USA
Meghna D. Patel
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, MI, USA Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
Swati Choudhry
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, MI, USA Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Karl Stessy Bisselou
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, NE, USA
Tim Sekarski
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, MI, USA
Mary Craft
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, NE, USA
Ling Li
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, NE, USA
Afif El Khuffash
Affiliation:
Department of Neonatology, The Rotunda Hospital & School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Aaron Hamvas
Affiliation:
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Shelby Kutty
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, NE, USA Division of Pediatric Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Gautam K. Singh
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, MI, USA
Philip T. Levy*
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, MI, USA Division of Newborn Medicine, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Philip T. Levy, MD, Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Avenue | Hunnewell 436, Boston, MA 02115, USA. Tel: (617) 919 6682; E-mail: philip.levy@childrens.harvard.edu
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Abstract

Introduction:

Prematurity impacts myocardial development and may determine long-term outcomes. The objective of this study was to test the hypothesis that preterm neonates develop right ventricle dysfunction and adaptive remodelling by 32 weeks post-menstrual age that persists through 1 year corrected age.

Materials and Methods:

A subset of 80 preterm infants (born <29 weeks) was selected retrospectively from a prospectively enrolled cohort and measures of right ventricle systolic function and morphology by two-dimensional echocardiography were assessed at 32 weeks post-menstrual age and at 1 year of corrected age. Comparisons were made to 50 term infants at 1 month and 1 year of age. Sub-analyses were performed in preterm-born infants with bronchopulmonary dysplasia and/or pulmonary hypertension.

Result:

In both term and preterm infants, right ventricle function and morphology increased over the first year (p < 0.01). The magnitudes of right ventricle function measures were lower in preterm-born infants at each time period (p < 0.01 for all) and right ventricle morphology indices were wider in all preterm infants by 1 year corrected age, irrespective of lung disease. Measures of a) right ventricle function were further decreased and b) morphology increased through 1 year in preterm infants with bronchopulmonary dysplasia and/or pulmonary hypertension (p < 0.01).

Conclusion:

Preterm infants exhibit abnormal right ventricle performance with remodelling at 32 weeks post-menstrual age that persists through 1 year corrected age, suggesting a less developed intrinsic myocardial function response following preterm birth. The development of bronchopulmonary dysplasia and pulmonary hypertension leave a further negative impact on right ventricle mechanics over the first year of age.

Keywords

Right ventricular functionprematuritystrain imagingechocardiographyneonates
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 945 - 953
Copyright
© Cambridge University Press 2019 

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