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Am J Respir Crit Care Med. 2018 Jun 26. doi: 10.1164/rccm.201710-2016OC. [Epub ahead of print]

Early Pulmonary Vascular Disease in Young Adults Born Preterm.

Author information

1
University of Wisconsin School of Medicine and Public Health, Division of Allergy, Pulmonary and Critical Care, Madison, Wisconsin, United States ; kngoss@medicine.wisc.edu.
2
University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin, United States.
3
University of Wisconsin-Madison, Pediatrics, Madison, Wisconsin, United States.
4
University of Wisconsin Madison School of Medicine and Public Health, 5232, Pediatrics, Kinesiology, Madison, Wisconsin, United States.
5
University of Wisconsin School of Medicine and Public Health, Pediatrics, Madison, Wisconsin, United States.
6
University of Wisconsin Madison School of Medicine and Public Health, 5232, Medicine, Madison, Wisconsin, United States.
7
University of Wisconsin Madison Graduate School, 53678, Biomedical Engineering, Madison, Wisconsin, United States.
8
University of Wisconsin Madison School of Medicine and Public Health, 5232, Pediatrics, Madison, Wisconsin, United States.
9
University of Wisconsin, Biostatistics and Medical Informatics, Madison, Wisconsin, United States.
10
University of Wisconsin, Orthopedics, Madison, Wisconsin, United States.
11
University of Wisconsin Madison School of Medicine and Public Health, 5232, Pediatrics, Medicine, Biomedical Engineering, Madison, Wisconsin, United States.

Abstract

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.

OBJECTIVE:

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 (≤1500g; average gestational age 28 weeks) 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.

RESULTS:

Preterm subjects had higher mean pulmonary arterial pressures (mPAP), with 27% (3/11) meeting criteria for borderline pulmonary hypertension (mPAP 19-24 mmHg) and 18% (2/11) meeting criteria for overt pulmonary hypertension (mPAP ≥25 mmHg). 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.

CONCLUSION:

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.

KEYWORDS:

Prematurity; Pulmonary Hypertension; Exercise; Bronchopulmonary Dysplasia; Right Ventricular Function

PMID:
29944842
PMCID:
PMC6298636
[Available on 2019-12-15]
DOI:
10.1164/rccm.201710-2016OC

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