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Original research article
Subtle increases in heart size persist into adulthood in growth restricted babies: the Cardiovascular Risk in Young Finns Study
  1. Clare Arnott1,2,3,
  2. Michael R Skilton4,
  3. Saku Ruohonen5,
  4. Markus Juonala6,7,
  5. Jorma S A Viikari8,
  6. Mika Kähönen9,
  7. Terho Lehtimäki10,
  8. Tomi Laitinen11,
  9. David S Celermajer2,12 and
  10. Olli T Raitakari5,13
  1. 1Faculty of Medicine, University of Sydney, Sydney, Australia
  2. 2Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
  3. 3Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
  4. 4Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
  5. 5Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
  6. 6Division of Medicine, Turku University Hospital, Turku, Finland
  7. 7Department of Medicine, University of Turku, Finland and Murdoch Children's Research Institute, Melbourne, Australia
  8. 8Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
  9. 9Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland
  10. 10Department of Clinical Chemistry, Fimlab Laboratories and University of Tampere School of Medicine, Tampere, Finland
  11. 11Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Finland
  12. 12Faculty of Medicine, University of Sydney, Sydney, Australia
  13. 13Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
  1. Correspondence to Professor David Celermajer; david.celermajer{at}email.cs.nsw.gov.au

Abstract

Background and objectives Impaired fetal growth is associated with increased cardiovascular morbidity and mortality in adulthood. We sought to determine whether adults born with intrauterine growth restriction have primary maladaptive changes in cardiac structure.

Methods Study participants were adults (34–49 years) who attended the 31-year follow-up of the Cardiovascular Risk in Young Finns Study (longitudinal cohort). Transthoracic echocardiograms and demographic and cardiovascular risk surveys were completed for 157 adults born small for gestational age (SGA, birth weight <10th population centile) and 627 born average for gestational age (average for gestational age (AGA), birth weight 50th–90th population centile).

Results Those born growth restricted had subtly enlarged hearts with indexed left ventricular (LV) end-systolic and end-diastolic diameters slightly greater in the SGA individuals than the AGA group (LVESD 18.7 mm/m2 SGA vs 18.1 mm/m2 AGA, p<0.01; LVEDD 27.5 mm/m2 SGA vs 26.6 mm/m2 AGA, p<0.01); LV base-to-apex length (47.4 mm/m2 SGA vs 46.0 mm/m2 AGA, p<0.01); LV basal diameter (26.4 mm/m2 SGA vs 25.7 mm/m2 AGA, p<0.01); and right ventricular base-to-apex length (40.1 mm/m2 SGA vs 39.2 mm/m2 AGA, p=0.02). LV stroke volume was greater in those born AGA (74.5 mL SGA vs 78.8 mL AGA, p<0.01), with no significant difference in cardiac output (5 L/min SGA vs 5.2 L/min AGA, p=0.06), heart rate, diastolic indices or sphericity index.

Conclusions Adults born SGA have some statistically significant but subtle changes in cardiac structure and function, which are less marked than have been described in childhood, and are unlikely to play a pathogenic role in their elevated cardiovascular risk.

  • CARDIAC FUNCTION

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