Cardiac dysfunction during exercise in young adults with bronchopulmonary dysplasia

Abstract

BackgroundWorldwide, 1–2% of children are born premature and at risk for developing bronchopulmonary dysplasia (BPD). Preterm-born adults are at risk for early cardiovascular disease. The role of BPD is unclear. This study aims to examine cardiorespiratory function during submaximal exercise in young adult survivors of extreme prematurity, with or without BPD.Methods40 preterm-born young adults, 20 with BPD (median gestational age 27 weeks, interquartile range (IQR) 26–28 weeks) and 20 without BPD (median gestational age 28 weeks, IQR 27–29 weeks) were prospectively compared to age-matched at term-born adults (median gestational age 39 weeks, IQR 38–40 weeks). Participants underwent exercise testing and cardiovascular magnetic resonance with submaximal exercise.ResultsResting heart rate in BPD subjects was higher than in at term-born subjects (69±10 mLversus61±7 mL, p=0.01). Peak oxygen uptake during maximal cardiopulmonary exercise testing was decreased in BPD subjects (91±18%versus106±17% of predicted, p=0.01). In BPD subjects, cardiac stroke volume change with exercise was impaired compared to at term-born subjects (11±13%versus25±10%; p<0.001). With exercise, left ventricular end-diastolic volume decreased more in preterm-born subjects withversuswithout BPD (−10±8%versus−3±8%; p=0.01) and compared to at term-born subjects (0±5%; p<0.001). Exploratory data analysis revealed that exercise stroke volume and end-diastolic volume change were inversely correlated with oxygen dependency in those born prematurely.ConclusionsIn preterm-born young adults, particularly those with BPD, resting cardiac function, exercise performance and cardiac response to exercise is impaired compared to controls. Exercise cardiovascular magnetic resonance may reveal an important predisposition for heart disease later in life.