Steenhorst Jarno J, Helbing Willem A, van Genuchten Wouter J, Bowen Daniel J, van den Bosch Annemien, van der Velde Nikki, Kamphuis Lieke S, Merkus Daphne, Reiss Irwin K M, Hirsch Alexander
Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
ERJ Open Res. 2024 Jun 17;10(3). doi: 10.1183/23120541.00501-2023. eCollection 2024 May.
Worldwide, 1-2% of children are born premature and at risk for developing bronchopulmonary dysplasia (BPD). Preterm-born adults are at risk for early cardiovascular disease. The role of BPD is unclear. This study aims to examine cardiorespiratory function during submaximal exercise in young adult survivors of extreme prematurity, with or without BPD.
40 preterm-born young adults, 20 with BPD (median gestational age 27 weeks, interquartile range (IQR) 26-28 weeks) and 20 without BPD (median gestational age 28 weeks, IQR 27-29 weeks) were prospectively compared to age-matched at term-born adults (median gestational age 39 weeks, IQR 38-40 weeks). Participants underwent exercise testing and cardiovascular magnetic resonance with submaximal exercise.
Resting heart rate in BPD subjects was higher than in at term-born subjects (69±10 mL 61±7 mL, p=0.01). Peak oxygen uptake during maximal cardiopulmonary exercise testing was decreased in BPD subjects (91±18% 106±17% of predicted, p=0.01). In BPD subjects, cardiac stroke volume change with exercise was impaired compared to at term-born subjects (11±13% 25±10%; p<0.001). With exercise, left ventricular end-diastolic volume decreased more in preterm-born subjects with without BPD (-10±8% -3±8%; p=0.01) and compared to at term-born subjects (0±5%; p<0.001). Exploratory data analysis revealed that exercise stroke volume and end-diastolic volume change were inversely correlated with oxygen dependency in those born prematurely.
In preterm-born young adults, particularly those with BPD, resting cardiac function, exercise performance and cardiac response to exercise is impaired compared to controls. Exercise cardiovascular magnetic resonance may reveal an important predisposition for heart disease later in life.
在全球范围内，1%-2%的儿童早产，有患支气管肺发育不良（BPD）的风险。早产的成年人有患早期心血管疾病的风险。BPD的作用尚不清楚。本研究旨在检查极早早产儿成年幸存者在次最大运动量运动期间的心肺功能，这些幸存者有无BPD。
前瞻性地比较了40名早产的年轻成年人，其中20名患有BPD（中位胎龄27周，四分位间距（IQR）26-28周），20名无BPD（中位胎龄28周，IQR 27-29周），并与年龄匹配的足月儿出生的成年人（中位胎龄39周，IQR 38-40周）进行比较。参与者接受了运动测试和次最大运动量运动时的心血管磁共振检查。
BPD受试者的静息心率高于足月儿出生的受试者（69±10次/分钟对61±7次/分钟，p=0.01）。BPD受试者在最大心肺运动测试期间的峰值摄氧量降低（为预测值的91±18%对106±17%，p=0.01）。与足月儿出生的受试者相比，BPD受试者运动时的心搏量变化受损（11±13%对25±10%；p<0.001）。运动时，有无BPD的早产受试者左心室舒张末期容积下降更多（-10±8%对-3±8%；p=0.01），且与足月儿出生的受试者相比（0±5%；p<0.001）。探索性数据分析显示，运动心搏量和舒张末期容积变化与早产者的氧依赖呈负相关。
与对照组相比，早产的年轻成年人，尤其是患有BPD的人，静息心功能、运动表现和心脏对运动的反应受损。运动心血管磁共振可能揭示日后患心脏病的重要易感性。
