Association between Neonatal Intakes and Hyperglycemia, and Left Heart and Aortic Dimensions at 6.5 Years of Age in Children Born Extremely Preterm

Survivors of extremely preterm birth (gestational age < 27 weeks) have been reported to exhibit an altered cardiovascular phenotype in childhood. The mechanisms are unknown. We investigated associations between postnatal nutritional intakes and hyperglycemia, and left heart and aortic dimensions in children born extremely preterm. Postnatal nutritional data and echocardiographic dimensions at 6.5 years of age were extracted from a sub-cohort of the Extremely Preterm Infants in Sweden Study (EXPRESS; children born extremely preterm between 2004–2007, n = 171, mean (SD) birth weight = 784 (165) grams). Associations between macronutrient intakes or number of days with hyperglycemia (blood glucose > 8 mmol/L) in the neonatal period (exposure) and left heart and aortic dimensions at follow-up (outcome) were investigated. Neonatal protein intake was not associated with the outcomes, whereas higher lipid intake was significantly associated with larger aortic root diameter (B = 0.040, p = 0.009). Higher neonatal carbohydrate intake was associated with smaller aorta annulus diameter (B = −0.016, p = 0.008). Longer exposure to neonatal hyperglycemia was associated with increased thickness of the left ventricular posterior wall (B = 0.004, p = 0.008) and interventricular septum (B = 0.004, p = 0.010). The findings in this study indicate that postnatal nutrition and hyperglycemia may play a role in some but not all long-lasting developmental adaptations of the cardiovascular system in children born extremely preterm.

Relationship between sporting discipline and aortic dimensions in middle-aged sportsmen

Funding Acknowledgements Type of funding sources: None. Background A previous study reported a high prevalence (21%) of clinically relevant aortic dilatation (≥40 mm) in competitive veteran runners and rowers. It is uncertain whether this also applies to middle-aged sportsmen performing other sporting disciplines. Purpose To relate aortic dimensions to sporting disciplines in middle-aged sportsmen. Methods Middle-aged sportsmen, ≥45 years of age, underwent coronary CT angiography. Aortic size was measured at the sinus of Valsalva (cusp-cusp) and the ascending aorta (at the height of the pulmonary trunk). Dominant sporting discipline was categorized as running, cycling or other. Analysis of variance was used to compare baseline characteristics and aortic dimensions across sporting disciplines. Multivariable linear regression was used to adjust for baseline characteristics. Results A total of 260 sportsmen (mean age 55.1 ± 6.4 years; 64 runners, 75 cyclists and 121 other sporting disciplines) were included (Table). Clinically relevant aortic dilatation was found in 5.0% (n = 13). Aortic size or presence of aortic dilatation did not differ across sporting disciplines. Ascending aorta and aortic root size were significantly related to age, body surface area, diastolic blood pressure and exercise tolerance, but not sporting disciplines. Conclusions We found clinically relevant aortic dilatation in 5% of middle-aged sportsmen. Aortic size was not different between sporting disciplines. Aortic size may be more related to level of exercise performance rather than sporting discipline. Running (n = 64) Cycling (n = 75) Other (n = 121) p value Participant characteristics Age, yrs 54.6 ± 6.4 56.1 ± 6.8 54.8 ± 6.2 0.30 Systolic BP, mmHg 129 ± 12 128 ± 13 129 ± 12 0.95 Diastolic BP, mmHg 80 ± 8 79 ± 8 80 ± 9 0.32 Body surface area, m2 2.03 ± 0.14 2.02 ± 0.15 2.07 ± 0.15 0.08 Exercise tolerance, Watt 310 ± 42* 329 ± 47 307 ± 48 0.003 Aortic dimensions Ascending aorta maximum diameter, mm 32.5 ± 3.1 33.0 ± 3.8 32.5 ± 3.6 0.64 SoV mean diameter, mm 34.3 ± 2.8 34.1 ± 2.8 33.7 ± 3.2 0.46 SoV, NCC-RCC diameter, mm 34.2 ± 2.9 34.0 ± 2.9 33.7 ± 3.4 0.61 Any aortic diameter ≥40 mm, n (%) 3 (4.7) 2 (2.7) 8 (6.6) 0.46 Values are mean SD or n (%). *significantly different from cycling and other. BP = blood pressure; SoV = sinus of Valsalva; NCC = non-coronary cusp; RCC = right coronary cusp

Validation of thoracic aortic dimensions on ECG-triggered SSFP as alternative to contrast-enhanced MRA

Objectives Assessment of thoracic aortic dimensions with non-ECG-triggered contrast-enhanced magnetic resonance angiography (CE-MRA) is accompanied with motion artefacts and requires gadolinium. To avoid both motion artefacts and gadolinium administration, we evaluated the similarity and reproducibility of dimensions measured on ECG-triggered, balanced steady-state free precession (SSFP) MRA as alternative to CE-MRA. Methods All patients, with varying medical conditions, referred for thoracic aortic examination between September 2016 and March 2018, who underwent non-ECG-triggered CE-MRA and SSFP-MRA (1.5 T) were retrospectively included (n = 30). Aortic dimensions were measured after double-oblique multiplanar reconstruction by two observers at nine landmarks predefined by literature guidelines. Image quality was scored at the sinus of Valsalva, mid-ascending aorta and mid-descending aorta by semi-automatically assessing the vessel sharpness. Results Aortic dimensions showed high agreement between non-ECG-triggered CE-MRA and SSFP-MRA (r = 0.99, p < 0.05) without overestimation or underestimation of aortic dimensions in SSFP-MRA (mean difference, 0.1 mm; limits of agreement, − 1.9 mm and 1.9 mm). Intra- and inter-observer variabilities were significantly smaller with SSFP-MRA for the sinus of Valsalva and sinotubular junction. Image quality of the sinus of Valsalva was significantly better with SSFP-MRA, as fewer images were of impaired quality (3/30) than in CE-MRA (21/30). Reproducibility of dimensions was significantly better in images scored as good quality compared to impaired quality in both sequences. Conclusions Thoracic aortic dimensions measured on SSFP-MRA and non-ECG-triggered CE-MRA were similar. As expected, SSFP-MRA showed better reproducibility close to the aortic root because of lesser motion artefacts, making it a feasible non-contrast imaging alternative. Key Points • SSFP-MRA provides similar dimensions as non-ECG-triggered CE-MRA. • Intra- and inter-observer reproducibilities improve for the sinus of Valsalva and sinotubular junction with SSFP-MRA. • ECG-triggered SSFP-MRA shows better image quality for landmarks close to the aortic root in the absence of cardiac motion.