Chang Hung-Yang, Chang Jui-Hsing, Peng Chun-Chih, Hsu Chyong-Hsin, Ko Mary Hsin-Ju, Hung Chung-Lieh, Chen Ming-Ren
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
Front Cardiovasc Med. 2022 May 6;9:879952. doi: 10.3389/fcvm.2022.879952. eCollection 2022.
Survivors of preterm birth are at risk of long-term cardiovascular consequences. The objective of this prospective observational study was to assess left heart function at preschool age in preterm children with very low birth weight (VLBW).
We recruited children aged 5-6 years from preterm infants and full-term children. All subjects underwent conventional echocardiography and speckle-tracking echocardiography. The results were compared between the preterm and term groups.
Eighty-seven VLBW preterm children and 29 term controls were included in the study. After adjusting for body surface area, the preterm group compared to the full-term group had significantly smaller left ventricular (LV) end-diastolic and end-systolic internal dimensions (31.2 vs. 33.5 mm, = 0.048; and 20.0 vs. 21.6 mm, respectively; = 0.024), lower LV end-diastolic and end-systolic volumes (38.8 vs. 46.3 mL, = 0.024; and 12.8 vs. 15.6 mL, respectively; = 0.008). Left atrial (LA) maximal and minimal volume were also significantly smaller in the preterm group (15.4 vs. 18.9 mL, = 0.017; and 6.2 vs 7.5 mL, respectively; = 0.018). LV global longitudinal strain (-21.4 vs. -23.2%, < 0.0001) and systolic strain rate (-1.30 vs. -1.37 /s, = 0.001) were significantly lower in the preterm group than in the term control group. LA longitudinal strain was decreased (43.9 vs. 52.8%, < 0.0001) and left atrial stiffness index (0.17 vs. 0.14, < 0.0001) was increased in preterm infants. However, all the measurements in both groups were within normal range.
Subclinical changes of left heart structure and function were found in VLBW infants at preschool age. Additional long-term follow-ups of the cardiovascular outcomes are needed in this vulnerable population.
早产幸存者面临长期心血管问题的风险。这项前瞻性观察性研究的目的是评估极低出生体重（VLBW）早产儿童学龄前的左心功能。
我们从早产婴儿和足月儿童中招募了5至6岁的儿童。所有受试者均接受了传统超声心动图和斑点追踪超声心动图检查。比较早产组和足月组的结果。
该研究纳入了87名极低出生体重早产儿童和29名足月对照儿童。调整体表面积后，与足月组相比，早产组的左心室（LV）舒张末期和收缩末期内径显著更小（分别为31.2 vs. 33.5 mm，P = 0.048；以及20.0 vs. 21.6 mm，P = 0.024），左心室舒张末期和收缩末期容积更低（分别为38.8 vs. 46.3 mL，P = 0.024；以及12.8 vs. 15.6 mL，P = 0.008）。早产组的左心房（LA）最大和最小容积也显著更小（分别为15.4 vs. 18.9 mL，P = 0.017；以及6.2 vs 7.5 mL，P = 0.018）。早产组的左心室整体纵向应变（-21.4 vs. -23.2%，P < 0.0001）和收缩期应变率（-1.30 vs. -1.37 /s，P = 0.001）显著低于足月对照组。早产婴儿的左心房纵向应变降低（43.9 vs. 52.8%，P < 0.0001），左心房僵硬度指数升高（0.17 vs. 0.14，P < 0.0001）。然而，两组的所有测量值均在正常范围内。
在学龄前的极低出生体重婴儿中发现了左心结构和功能的亚临床变化。需要对这一脆弱人群的心血管结局进行额外的长期随访。
