John Hunter Children's Hospital, Newcastle, NSW, Australia.
University of Newcastle, Newcastle, NSW, Australia.
Pediatr Res. 2020 Jan;87(1):146-152. doi: 10.1038/s41390-019-0568-4. Epub 2019 Sep 7.
Young adults born preterm have remodeled hearts, i.e., altered cardiac shape and size with impaired cardiac function. At present, the natural history and pattern of prematurity related cardiac remodeling are not clearly established. The aim of this study was to compare the left ventricle (LV) geometry and function of preterm infants at 36 weeks postmenstrual age (PMA) with gestation matched newborn infants.
LV end diastolic volume index (LV EDVI), LV mass index (LVMI), relative wall thickness (RWT), and sphericity index (SI) were prospectively obtained with echocardiography. LV geometry was classified according to the Gaasch method. LV function was assessed by determining ejection fraction (EF), longitudinal strain (LS), mitral annulus systolic motion (s'), and estimated LV filling pressure (E/e').
Eighty-three preterm infants between 23 and 29 weeks gestation, and 40 infants of 36 weeks gestation at birth were analysed. LV EDVI, LVMI, SI, LS, s', and E/e' were higher in preterm group while RWT and EF were comparable between groups. LV showed normal geometry in 55.4%, physiological enlargement in 23% and dilated hypertrophy in 21.6% preterm infants.
At 36 week, preterm infants have significantly dilated, hypertrophied, and more spherical LV with impaired diastolic function compared with PMA matched newborn infants.
早产儿的心脏会发生重构，即心脏的形状和大小发生改变，同时伴有心脏功能受损。目前，与早产儿相关的心脏重构的自然史和模式尚不清楚。本研究的目的是比较孕龄相匹配的足月儿与 36 周校正胎龄（postmenstrual age，PMA）早产儿的左心室（left ventricle，LV）几何形状和功能。
前瞻性地使用超声心动图获取 LV 舒张末期容积指数（LV EDVI）、LV 质量指数（LVMI）、相对室壁厚度（RWT）和球形指数（SI）。根据 Gaasch 方法对 LV 几何形状进行分类。通过测定射血分数（ejection fraction，EF）、纵向应变（longitudinal strain，LS）、二尖瓣环收缩期运动（s'）和估计的 LV 充盈压（E/e'）来评估 LV 功能。
共分析了 83 名孕 23-29 周出生的早产儿和 40 名孕 36 周出生的足月儿。与足月儿相比，早产儿的 LV EDVI、LVMI、SI、LS、s'和 E/e'更高，而 RWT 和 EF 两组间无差异。LV 在早产儿中呈现正常几何形状占 55.4%，生理性增大占 23%，扩张性肥厚占 21.6%。
与 PMA 相匹配的足月儿相比，36 周校正胎龄的早产儿的 LV 明显扩张、肥厚且更呈球形，舒张功能受损。
