Odri Komazec Irena, Posod Anna, Schwienbacher Martin, Resch Maria, Pupp Peglow Ulrike, Kiechl Stefan, Baumgartner Daniela, Kiechl-Kohlendorfer Ursula
From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.).
Arterioscler Thromb Vasc Biol. 2016 Nov;36(11):2268-2274. doi: 10.1161/ATVBAHA.116.308144. Epub 2016 Sep 22.
Preterm birth predisposes children to the development of cardiovascular diseases in adulthood. The aim of this study was to characterize elastic properties of the aorta at preschool age and test the hypothesis that prematurity is associated with decreased aortic distensibility and increased stiffness, both of which are predictors of increased cardiovascular risk.
In an observational study of 76 five- to seven-year-old children born at a gestational age <32 weeks and 79 term-born controls, elastic parameters of the ascending and descending abdominal aorta were determined noninvasively by means of M mode echocardiographic tracings and calculated using computerized wall contour analysis. Compared with children born at term, the preterm group showed significantly reduced distensibility and increased stiffness of the descending abdominal aorta. These results remained significant under multivariable adjustment for birth weight z score, maternal smoking in pregnancy, maternal education, family history of cardiovascular disease, breastfeeding, childhood nutrition, and current body mass index z score (multivariable odds ratios and 95% confidence intervals 5.1, 1.7-15.9; P=0.005 and 2.8, 1.0-7.9; P=0.046, respectively). Further adjustment for intravenous lipid therapy attenuated the strength of association. Elastic properties of the ascending aorta did not differ between the 2 study groups.
Children born preterm are characterized by decreased elastic properties of the descending abdominal aorta potentially attributable to impaired viscoelastic properties of and lipid damage to the aorta. Clinical follow-up of preterm infants with a focus on aortic elastic properties may be useful for tailoring early prevention programs and counteracting cardiovascular risk in adulthood.
早产使儿童成年后患心血管疾病的风险增加。本研究旨在描述学龄前儿童主动脉的弹性特性，并验证以下假设：早产与主动脉扩张性降低和僵硬度增加有关，而这两者均是心血管风险增加的预测因素。
在一项观察性研究中，对76名胎龄<32周出生的5至7岁儿童和79名足月儿对照进行研究，通过M型超声心动图描记术对升主动脉和降主动脉的弹性参数进行无创测定，并使用计算机化壁轮廓分析进行计算。与足月儿相比，早产组降主动脉的扩张性显著降低，僵硬度增加。在对出生体重z评分、孕期母亲吸烟、母亲教育程度、心血管疾病家族史、母乳喂养、儿童营养状况和当前体重指数z评分进行多变量调整后，这些结果仍然显著（多变量优势比和95%置信区间分别为5.1, 1.7 - 15.9；P = 0.005和2.8, 1.0 - 7.9；P = 0.046）。进一步对静脉脂质治疗进行调整后，关联强度减弱。两个研究组升主动脉的弹性特性无差异。
早产出生的儿童降主动脉弹性特性降低，这可能归因于主动脉粘弹性受损和脂质损伤。对早产儿进行以主动脉弹性特性为重点的临床随访，可能有助于制定早期预防方案并降低成年期心血管风险。
