TY - JOUR
T1 - Early pulmonary vascular disease in young adults born preterm
AU - Goss, Kara N.
AU - Beshish, Arij G.
AU - Barton, Gregory P.
AU - Haraldsdottir, Kristin
AU - Levin, Taylor S.
AU - Tetri, Laura H.
AU - Battiola, Therese J.
AU - Mulchrone, Ashley M.
AU - Pegelow, David F.
AU - Palta, Mari
AU - Lamers, Luke J.
AU - Watson, Andrew M.
AU - Chesler, Naomi C.
AU - Eldridge, Marlowe W.
N1 - Funding Information:
Supported by NIH grants 1R01 HL086897 (M.W.E.), R01 HL38149 (M.W.E.), 1R01HL086939 (N.C.C.), and 1R01HL105598 (N.C.C.). K.N.G. is supported by the University of Wisconsin Clinical and Translational Science Award program, through the NIH National Center for Advancing Translational Sciences grant NIH UL1TR000427 (Primary Investigator Marc Drezner; 4KL2TR000428-10). Assembly of the Newborn Lung Cohort was supported by grant R01 HL38149 (M.P.).
Publisher Copyright:
Copyright © 2018 by the American Thoracic Society.
PY - 2018/12/15
Y1 - 2018/12/15
N2 - Rationale: Premature birth affects 10% of live births in the United States and is associated with alveolar simplification and altered pulmonary microvascular development. However, little is known about the long-term impact prematurity has on the pulmonary vasculature. Objectives: Determine the long-term effects of prematurity on right ventricular and pulmonary vascular hemodynamics. Methods: Preterm subjects (n = 11) were recruited from the Newborn Lung Project, a prospectively followed cohort at the University of Wisconsin-Madison, born preterm with very low birth weight (< 1,500 g; average gestational age, 28 wk) between 1988 and 1991. Control subjects (n = 10) from the same birth years were recruited from the general population. All subjects had no known adult cardiopulmonary disease. Right heart catheterization was performed to assess right ventricular and pulmonary vascular hemodynamics at rest and during hypoxic and exercise stress. Measurements and Main Results: Preterm subjects had higher mean pulmonary arterial pressures (mPAPs), with 27% (3 of 11) meeting criteria for borderline pulmonary hypertension (mPAP, 19-24 mm Hg) and 18% (2 of 11) meeting criteria for overt pulmonary hypertension (mPAP > 25 mm Hg). Pulmonary vascular resistance and elastance were higher at rest and during exercise, suggesting a stiffer vascular bed. Preterm subjects were significantly less able to augment cardiac index or right ventricular stroke work during exercise. Among neonatal characteristics, total ventilatory support days was the strongest predictor of adult pulmonary pressure. Conclusions: Young adults born preterm demonstrate early pulmonary vascular disease, characterized by elevated pulmonary pressures, a stiffer pulmonary vascular bed, and right ventricular dysfunction, consistent with an increased risk of developing pulmonary hypertension.
AB - Rationale: Premature birth affects 10% of live births in the United States and is associated with alveolar simplification and altered pulmonary microvascular development. However, little is known about the long-term impact prematurity has on the pulmonary vasculature. Objectives: Determine the long-term effects of prematurity on right ventricular and pulmonary vascular hemodynamics. Methods: Preterm subjects (n = 11) were recruited from the Newborn Lung Project, a prospectively followed cohort at the University of Wisconsin-Madison, born preterm with very low birth weight (< 1,500 g; average gestational age, 28 wk) between 1988 and 1991. Control subjects (n = 10) from the same birth years were recruited from the general population. All subjects had no known adult cardiopulmonary disease. Right heart catheterization was performed to assess right ventricular and pulmonary vascular hemodynamics at rest and during hypoxic and exercise stress. Measurements and Main Results: Preterm subjects had higher mean pulmonary arterial pressures (mPAPs), with 27% (3 of 11) meeting criteria for borderline pulmonary hypertension (mPAP, 19-24 mm Hg) and 18% (2 of 11) meeting criteria for overt pulmonary hypertension (mPAP > 25 mm Hg). Pulmonary vascular resistance and elastance were higher at rest and during exercise, suggesting a stiffer vascular bed. Preterm subjects were significantly less able to augment cardiac index or right ventricular stroke work during exercise. Among neonatal characteristics, total ventilatory support days was the strongest predictor of adult pulmonary pressure. Conclusions: Young adults born preterm demonstrate early pulmonary vascular disease, characterized by elevated pulmonary pressures, a stiffer pulmonary vascular bed, and right ventricular dysfunction, consistent with an increased risk of developing pulmonary hypertension.
KW - Bronchopulmonary dysplasia
KW - Exercise
KW - Prematurity
KW - Pulmonary hypertension
KW - Right ventricular function
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U2 - 10.1164/rccm.201710-2016OC
DO - 10.1164/rccm.201710-2016OC
M3 - Article
C2 - 29944842
AN - SCOPUS:85053211096
SN - 1073-449X
VL - 198
SP - 1549
EP - 1558
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 12
ER -