Association of Preterm Birth With Myocardial Fibrosis and Diastolic Dysfunction in Young Adulthood

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Abstract

Background

Preterm birth affects about 10% of live births worldwide and is associated with cardiac alterations. Animal models of preterm birth suggest that left ventricular functional impairment may be due to an up-regulation of myocardial fibrosis.

Objectives

The aim of this study was to determine whether diffuse left ventricular fibrosis is evident in young adults born preterm.

Methods

One hundred one normotensive young adults born preterm (n = 47, mean gestational age 32.8 ± 3.2 weeks) and term (n = 54) were included from YACHT (Young Adult Cardiovascular Health sTudy). Left ventricular structure and function were quantified by cardiovascular magnetic resonance and echocardiography. Intravenous administration of a gadolinium-based contrast agent during cardiovascular magnetic resonance was used to quantify focal myocardial fibrosis on the basis of late gadolinium enhancement and, in combination with T1 mapping, to quantify diffuse myocardial fibrosis on the basis of assessment of myocardial extracellular volume fraction.

Results

Adults born preterm had smaller left ventricular end-diastolic and stroke volumes, with greater left ventricular mass and wall thickness ( P < 0.001). In addition, longitudinal peak systolic strain and diastolic strain rate by both cardiovascular magnetic resonance and echocardiography, and E/A ratio measured by echocardiography, were lower in preterm-born compared to term-born adults ( P < 0.05). Extracellular volume fraction was greater in preterm-born compared with term-born adults (27.81% ± 1.69% vs 25.48% ± 1.41%; P < 0.001) and was a significant mediator in the relationship between gestational age and both longitudinal peak diastolic strain rate and E/A ratio.

Conclusions

Preterm-born young adults have greater extracellular volume fraction in the left ventricle that is inversely related with gestational age and may underlie their diastolic functional impairments.

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Most cited references 41

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The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.

Reuben M. Baron, David A Kenny (1986)

In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.

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Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis

Saifon Chawanpaiboon, Joshua P. Vogel, Ann-Beth Moller … (2018)

Summary Background Preterm birth is the leading cause of death in children younger than 5 years worldwide. Although preterm survival rates have increased in high-income countries, preterm newborns still die because of a lack of adequate newborn care in many low-income and middle-income countries. We estimated global, regional, and national rates of preterm birth in 2014, with trends over time for some selected countries. Methods We systematically searched for data on preterm birth for 194 WHO Member States from 1990 to 2014 in databases of national civil registration and vital statistics (CRVS). We also searched for population-representative surveys and research studies for countries with no or limited CRVS data. For 38 countries with high-quality data for preterm births in 2014, data are reported directly. For countries with at least three data points between 1990 and 2014, we used a linear mixed regression model to estimate preterm birth rates. We also calculated regional and global estimates of preterm birth for 2014. Findings We identified 1241 data points across 107 countries. The estimated global preterm birth rate for 2014 was 10·6% (uncertainty interval 9·0–12·0), equating to an estimated 14·84 million (12·65 million–16·73 million) live preterm births in 2014. 12· 0 million (81·1%) of these preterm births occurred in Asia and sub-Saharan Africa. Regional preterm birth rates for 2014 ranged from 13·4% (6·3–30·9) in North Africa to 8·7% (6·3–13·3) in Europe. India, China, Nigeria, Bangladesh, and Indonesia accounted for 57·9 million (41×4%) of 139·9 million livebirths and 6·6 million (44×6%) of preterm births globally in 2014. Of the 38 countries with high-quality data, preterm birth rates have increased since 2000 in 26 countries and decreased in 12 countries. Globally, we estimated that the preterm birth rate was 9×8% (8×3–10×9) in 2000, and 10×6% (9×0–12×0) in 2014. Interpretation Preterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting. Funding WHO and the March of Dimes.

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Fibrosis--a common pathway to organ injury and failure.

Dan L Longo, Don C. Rockey, P Darwin Bell … (2015)

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Author and article information

Contributors

Adam J. Lewandowski: @DrAJLewandowski

Journal

Journal ID (nlm-ta): J Am Coll Cardiol

Journal ID (iso-abbrev): J Am Coll Cardiol

Title: Journal of the American College of Cardiology

Publisher: Elsevier Biomedical

ISSN (Print): 0735-1097

ISSN (Electronic): 1558-3597

Publication date PMC-release: 17 August 2021

Publication date (Print): 17 August 2021

Volume: 78

Issue: 7

Pages: 683-692

Affiliations

[a ]Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom

[b ]Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom

[c ]Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

[d ]Hôpital du Sacré-Cœur de Montréal Research Center (CIUSSS Nord-de-l’Île-de-Montréal), School of Physical and Occupational Therapy, McGill University, Montréal, Quebec, Canada

[e ]Department of Diagnostic Imaging & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Author notes

[∗ ] Address for correspondence: Dr Adam J. Lewandowski, Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. adam.lewandowski@ 123456cardiov.ox.ac.uk @DrAJLewandowski

Article

Publisher Item ID: S0735-1097(21)05393-6

DOI: 10.1016/j.jacc.2021.05.053

PMC ID: 8363934

PubMed ID: 34384550

SO-VID: 03d94035-a0c3-4322-84ea-e68193fc1ca6

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 10 March 2021

Date revision received : 23 April 2021

Date accepted : 18 May 2021

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Association of Preterm Birth With Myocardial Fibrosis and Diastolic Dysfunction in Young Adulthood

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Abstract

Background

Objectives

Methods

Results

Conclusions

Central Illustration

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Cardiovascular Innovations and Applications

Most cited references 41

The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.

Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis

Fibrosis--a common pathway to organ injury and failure.

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Cited by 21

Most referenced authors 695