Radboud University Medical Centre, Nijmegen, the Netherlands.
Department of Neonatology, John Hunter Children's Hospital and University of Newcastle, Newcastle, NSW, Australia.
Early Hum Dev. 2020 Dec;151:105168. doi: 10.1016/j.earlhumdev.2020.105168. Epub 2020 Aug 26.
There is growing evidence that preterm birth is a risk factor for early heart failure as a result of cardiac remodeling during a critical period of growth and development. The aim of this study was to explore if cardiac remodeling can be detected very early after preterm birth, and if present, if those remodeling changes persist until discharge.
Echocardiography parameters of left ventricular geometry and function were prospectively obtained with echocardiography in preterm infants <30 weeks gestation at postnatal day 3 and at 36 weeks postmenstrual age (PMA). Findings were compared to available data of healthy fetuses and cardiac remodeling was classified based on changes in left ventricular volume and/or mass.
65 (37 male) preterm infants were analysed. Three days after birth, 27.7% of infants had abnormal LV geometry, with immaturity and fetal growth restriction as risk factors for these early cardiac remodeling changes. At 36 weeks PMA, after a median period of 9 weeks of neonatal intensive care, 69.2% had abnormal cardiac geometry which could be classified as dilated hypertrophic remodeling (50.0%), dilated remodeling (11.5%) and hypertrophic remodeling (7.7%).
Cardiac remodeling changes can be detected very early after preterm birth. However, most changes take place during the neonatal intensive care period. The findings of this study could assist in identifying a group where an early and short-term intervention has the potential to prevent a pathway of abnormal cardiac development.
越来越多的证据表明，早产是心力衰竭的一个危险因素，这是由于在生长和发育的关键时期心脏发生重塑。本研究旨在探讨早产儿在出生后早期是否会发生心脏重塑，如果存在，这些重塑变化是否会持续到出院。
通过超声心动图在早产儿<30 孕周的出生后第 3 天和 36 孕周（胎龄）时，前瞻性地获得左心室几何形状和功能的超声心动图参数。将这些结果与健康胎儿的可用数据进行比较，并根据左心室容量和/或质量的变化来分类心脏重塑。
共分析了 65 名（37 名男性）早产儿。出生后 3 天，27.7%的婴儿存在异常 LV 几何形状，不成熟和胎儿生长受限是这些早期心脏重塑变化的危险因素。在 36 孕周 PMA 时，经过中位数为 9 周的新生儿重症监护后，69.2%的婴儿存在异常的心脏几何形状，可分为扩张性肥厚性重塑（50.0%）、扩张性重塑（11.5%）和肥厚性重塑（7.7%）。
早产儿在出生后早期即可检测到心脏重塑变化。然而，大多数变化发生在新生儿重症监护期间。本研究的结果可以帮助识别出一个群体，早期和短期干预有可能预防异常心脏发育的发生。
