Differing Impact of Preterm Birth on the Right and Left Atria in Adulthood

Art Schuermans, Tamara Den Harink, Betty Raman, Robert W. Smillie, Maryam Alsharqi, Afifah Mohamed, Winok Lapidaire, Arend W. van Deutekom, Paul Leeson, Adam J. Lewandowski*

*Corresponding author for this work

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Abstract

BACKGROUND: Preterm birth affects 10% of live births and is associated with an altered left ventricular and right ventricular phenotype and increased cardiovascular disease risk in young adulthood. Because left atrial (LA) and right atrial (RA) volume and function are known independent predictors of cardiovascular outcomes, we investigated whether these were altered in preterm-born young adults. METHODS AND RESULTS: Preterm-born (n=200) and term-born (n=266) adults aged 18 to 39 years underwent cardiovascular magnetic resonance imaging. LA and RA maximal and minimal volumes (absolute, indexed to body surface area, and as a ratio to ventricular volumes) were obtained to study atrial morphology, while LA and RA stroke volume, strain, and strain rate were used to assess atrial function. Secondary analyses consisted of between-group comparisons based on degree of pre-maturity. Absolute RA volumes and RA volumes indexed to right ventricular volumes were significantly smaller in preterm-born compared with term-born adults. In addition, RA reservoir and booster strain were higher in preterm-born adults, possibly indicating functional compensation for the smaller RA volumes. LA volumes indexed to left ventricular volumes were significantly greater in preterm-born adults as compared with term-born adults, although absolute LA volumes were similar between groups. LA and RA changes were observed across gestational ages in the preterm group but were greatest in those born very-to-extremely preterm. CONCLUSIONS: Preterm-born adults show changes in LA and RA structure and function, which may indicate subclinical cardiovascular disease. Further research into underlying mechanisms, opportunities for interventions, and their prognostic value is warranted.

Original languageEnglish
Article numbere027305
JournalJournal of the American Heart Association
Volume11
Issue number23
DOIs
Publication statusPublished - 6 Dec 2022

Bibliographical note

Funding Information:
The British Heart Foundation (BHF) and the Wellcome Trust provided study funding. The authors acknowledge support from the Oxford BHF Centre for Research Excellence and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. Dr Lewandowski is funded by a British Heart Foundation Intermediate Research Fellowship (FS/18/3/33292).

Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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