Abstract
Background
Premature birth is associated with ventricular remodeling, early heart failure, and altered left ventricular (LV) response to physiological stress.
Using computational cardiac magnetic resonance (CMR) imaging, we aimed to quantify preterm ventricular remodeling in the neonatal period, and explore contributory clinical factors.
Methods
Seventy-three CMR scans (34 preterm infants, 10 term controls) were performed to assess in-utero development and preterm ex-utero growth.
End-diastolic computational atlases were created for both cardiac ventricles; t statistics, linear regression modeling, and principal component analysis (PCA) were used to describe the impact of prematurity and perinatal factors on ventricular volumetrics, ventricular geometry, myocardial mass, and wall thickness.
Results
All preterm neonates demonstrated greater weight-indexed LV mass and higher weight-indexed end-diastolic volume at term-corrected age (P < 0.05 for all preterm gestations). Independent associations of increased term-corrected age LV myocardial wall thickness were (false discovery rate <0.05): degree of prematurity, antenatal glucocorticoid administration, and requirement for >48 h postnatal respiratory support.
PCA of LV geometry showed statistical differences between all preterm infants at term-corrected age and term controls.
Conclusions
Computational CMR demonstrates that significant LV remodeling occurs soon after preterm delivery and is associated with definable clinical situations. This suggests that neonatal interventions could reduce long-term cardiac dysfunction.
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Acknowledgements
The Image Registration Toolkit was used under Academic License from Ixico Ltd. This study was supported by the Centre for the Developing Brain, King’s College London & Department of Computing, Imperial College London. Funding for the study was received from the Medical Research Council & SPARKS Children’s Medical Research charity (in the form of a Clinical Research Fellowship grant for Dr. David Cox, 2012–2015).
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Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data—D.J.C., W.B., A.N.P., D.R., A.D.E. and A.M.G. Drafting the article or revising it critically for important intellectual content—DJ.C., W.B., A.N.P., D.R., A.D.E. and A.M.G. Final approval of the version to be published—D.J.C., A.D.E. and A.M.G.
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Cox, D.J., Bai, W., Price, A.N. et al. Ventricular remodeling in preterm infants: computational cardiac magnetic resonance atlasing shows significant early remodeling of the left ventricle. Pediatr Res 85, 807–815 (2019). https://doi.org/10.1038/s41390-018-0171-0
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DOI: https://doi.org/10.1038/s41390-018-0171-0
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