PERINATAL ANTECEDENTS OF VENTRICULAR-ARTERIAL COUPLING IN 11-YEAR-OLD CHILDREN BORN EXTREMELY PREMATURELY OR AT TERM

Objective: To investigate how ELBW birth premature birth affects ventricular-arterial coupling. Design and method: Single-center case-control study in Northern Belgium, including 93 extremely-low-birth-weight (ELWBW) cases (participation rate, 66.4%) and 97 sex-and age-matched volunteers as controls. Systolic (SBP) and diastolic (DBP) blood pressure, central arterial properties assessed by radial tonometry, echocardiographic structure and function, and ventricular-arterial coupling. Results: None of the arterial or echocardiographic traits were consistently correlated with birth weight in cases or controls. Compared with controls, cases were 4.1 (95% CI, 1.3-7.0) cm smaller and 4.1 (1.3-6.9 kg) lighter, had 7.3/3.0 (4.7-9.9/1.1-4.8) mm Hg higher central SBP/DBP, but lower end-diastolic and end-systolic LV dimensions resulting in-and a 9.12 g (3.7 to 14.6 g) lower LV mass. However, LV volumes and mass were similarly associated with weight and height in cases and controls (0.390< r < 0.614 versus 0.470 < r < 0.711; P > .12), suggesting maintenance of the proportionality of cardiac growth with body size (0.390 < r < 0.614 versus 0.470 < r < 0.711; P > .12). Despite a higher heart rate in cases 3.7 (0.1-7.3) bpm, cardiac output was 0.38 (0.15-0.61) L/min lower smaller in cases, together with a which resulted in hig her peripheral resistance (29.35 versus 24.4 mm Hg x min/L) and higher systolic augmentation ratio (1.10 versus 1.05), possibly because reflection points from which the backward pulse wave originated were closer to the heart. This suboptimal hemodynamic constellation in cases increased cardiac work and oxygen demand as reflected by the higher tension-time index (2171 versus 1940 mm Hg). As suggested by the E/e’ ratio, LV diastolic filling pressure was higher in cases (6.20 versus 5.78). Conclusions: School-aged 11-year-old children born with ELBW have stiffer central arteries, and altered cardiac structure and function compared with normal controls, leading to impaired left-sided ventricular-arterial coupling. Supporting pregnant women to give birth at term is among the most impactful steps in the pursuit of health equity.