Elevated Blood Pressure with Reduced Left Ventricular and Aortic Dimensions in Adolescents Born Extremely Preterm

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• 作者：Remi R. Kowalski ; MBBS¹ ; ² ; ³ ; ^{remi.kowalski@rch.org.au" class="auth_mail" title="E-mail the corresponding author} ; Richard Beare ; PhD⁴ ; Lex W. Doyle ; MD³ ; ⁵ ; ⁶ ; Joseph J. Smolich ; PhD¹ ; ³ ; Michael M.H. Cheung ; MD¹ ; ² ; ³ ; on behalf of the Victorian Infant Collaborative Study Group^&lowast ; ; Catherine Callanan ; RN ; Noni Davis ; Cinzia R. De Luca ; BSc ; PhD ; Julianne Duff ; FRACP ; Esther Hutchinson ; BSc (Hons) ; Elaine Kelly ; MA ; Marion McDonald ; RN ; FRACP ; Carly Molloy ; PhD ; Michelle Wilson-Ching ; PhD ; Peter Anderson ; PhD ; Alice Burnett ; PhD ; Elizabeth Carse ; FRACP ; Margaret P. Charlton ; MEd Psych ; Marie Hayes ; RN ; Elaine Kelly ; MA ; Gillian Opie ; FRACP ; Andrew Watkins ; FRACP ; Amanda Williamson ; BA ; Heather Woods ; RN ; Gehan Roberts ; MPH ; PhD ; FRACP ; Colin Robertson ; MD ; Stephen Wood ; PhD
• 关键词：AGA ; Appropriate weight for gestational age ; AIx ; Augmentation index ; BSA ; Body surface area ; cIMT ; Carotid intima-media thickness ; IUGR ; In utero growth restriction ; LV ; Left ventricle ; PWV ; Pulse wave velocity ; SGA ; Small for gestational age
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：172
• 期：Complete
• 页码：75-80.e2
• 全文大小：246 K

文摘

To evaluate the long-term cardiovascular effects of extremely preterm birth in a cohort of adolescents followed prospectively, who were largely free from intrauterine growth restriction.

Study design

Central blood pressures, aortic and cardiac dimensions, left ventricle (LV) function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were measured in 18-year-old subjects born extremely preterm at <28 weeks' gestation (n = 109) and term-born controls (n = 81).

Results

Compared with controls, preterm adolescents had higher systolic (124 ± 13 vs 118 ± 10 mm Hg, P = .002) and diastolic (72 ± 8 vs 67 ± 7 mm Hg, P < .001) blood pressures, but lower ascending aortic z-scores (0.13 ± 0.89 vs 0.42 ± 0.78, P = .02), LV diastolic (48.5 ± 4 vs 50.3 ± 4.5 mm, P = .007) and systolic (30.2 ± 3.5 vs 31.9 ± 4.0 mm, P = .003) diameters, and a reduced LV mass (130 ± 34 vs 145 ± 41 g, P = .01) and mass index (75 ± 14 vs 81 ± 16 g/m², P = .02). However, LV relative wall thickness, LV function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were similar. Within the ex-preterm group, there were no significant relationships between birthweight z-scores and any cardiovascular measures, once the latter were adjusted for current body size.

Conclusions

Extremely preterm birth had relatively minor cardiovascular effects in late-adolescence, with increased blood pressures, decreased LV, and aortic size, but preserved LV function, macrovascular properties, and microvascular function. In utero growth was not independently related to cardiovascular function within the ex-preterm cohort.