Premature Birth
Conditions
Keywords
cardiac function, preterm, children
Brief summary
The purpose of the CHAPTER study is to help understand how complications during pregnancy, such as preterm birth, affect how childrens' hearts and blood vessels develop.
Detailed description
Young adults born preterm (less than 37 weeks gestation) have alterations in the structure and function of the heart, with similar changes observed in preterm infants in the first three months of life. It is unknown whether these early changes in the heart seen in the first few months of life are relevant to long-term changes in heart structure and function. Heart changes have also not been well studied in children born preterm. To investigate this, the study will follow up children from the EPOCH study and will perform two study visits for each child (n=100 preterm and n=100 term) that will use echocardiography and cardiovascular magnetic resonance. Individuals in the EPOCH study had echocardiography measures done at birth and three months postnatal age. It will therefore be possible to do longitudinal echocardiography measures from birth up to ages 12 years to determine whether postnatal heart changes in preterm infants track into childhood. Cardiovascular magnetic resonance will allow for the determination of whether these early heart changes influence heart pump function. Finally, by measuring lung function, blood vessel structure and function, and blood pressure, it will be possible to determine how heart changes relate to other components of the cardiovascular system. This data will be used to confirm the relevance of early heart remodelling in preterm-born offspring over time and provide more comprehensive heart phenotyping for preterm-born children. Together, this information can be used to design future intervention strategies in preterm-born individuals to reduce cardiovascular risk in this growing subgroup of the population.
Interventions
None listed
Sponsors
University of Oxford
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
3 Years to 9 Years
Inclusion criteria
* Participant's parent or legal guardian gives consent and the participant, where age-appropriate, gives assent for participation in the study. * Participant is male or female, aged 3-9 years at enrolment. * Participant previously took part in the EPOCH study, or the participant's friend or sibling took part.
Exclusion criteria
* Evidence of congenital heart disease or significant chronic disease relevant to cardiovascular or metabolic status For exclusion of MRI component only: * Contraindication to MRI * Unsuitable for MRI based on the responses to the MRI screening form
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac left ventricular mass | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of left ventricular mass indexed to body surface area (in g and g/m\^2) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac left ventricular diastolic function | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of right ventricular (RV) diastolic function: RV Doppler early/late diastolic tricuspid inflow velocity ratio (E/A) |
| Cardiac flow dynamics of the left ventricle | 6-9 years of age | MRI assessment of direct flow, delayed ejection flow, retained inflow, residual volume kinetic energy flow components at end diastole (measured at end diastole in mJ and overall % contribution) |
| Body height | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Body weight measured in m |
| Body mass index | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Body weight divided by the square of height (in kg/m2) |
| Systolic blood pressure measurement | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Resting brachial blood pressure measurement (in mmHg) |
| Diastolic blood pressure measurement | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Resting brachial blood pressure measurement (in mmHg) |
| Mean arterial pressure | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | The average arterial pressure from resting brachial blood pressure measurement (in mmHg) |
| Retinal arteriolar structure | 6-9 years of age | Central retinal arteriolar equivalent (CRAE in μm) measured using retinal imaging |
| Retinal venular structure | 6-9 years of age | Central retinal venular equivalent (CRVE in μm) measured using retinal imaging |
| Retinal arteriolar-to-venular diameter ratio (AVR) | 6-9 years of age | The ratio of average retinal arteriolar diameter (CRAE in μm) and average retinal venous diameter (CRVE in μm) measured using retinal imaging |
| Lung function | 6-9 years of age | The forced expiratory volume in one second (FEV1 in L), forced vital capacity (FVC in L), and the ratio of FEV1 to FVC (FEV1/FVC) measured using spirometry |
| Objective measure of physical activity | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | The amount of moderate to vigorous physical activity (in h/week) and vigorous physical activity (in h/week) measured using wrist worn accelerometer |
| Mid-arm circumference | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Mid-arm circumference measured in cm |
| Waist-to-hip ratio | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | The ratio of waist circumference (in cm) to hip circumference (in cm) |
| Cardiac right ventricular mass | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of right ventricular mass indexed to body surface area (in g and g/m\^2) |
| Cardiac left ventricular end-diastolic volume | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of cardiac left ventricular end-diastolic volume indexed to body surface area (in ml and ml/m\^2) |
| Cardiac right ventricular end-diastolic volume | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of cardiac right ventricular end-diastolic volume indexed to body surface area (in ml and ml/m\^2) |
| Cardiac left ventricular systolic function | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of left ventricular systolic function: left ventricular ejection fraction (in %) |
| Cardiac right ventricular systolic function | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of right ventricular systolic function: tricuspid annular plane systolic excursion (in cm) |
| Body weight | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Body weight measured in kg |
| Cardiac right ventricular diastolic function | 3-5 years of age OR 8-12 years of age; AND 6-9 years of age | Echocardiography assessment of left ventricular (LV) diastolic function: LV Doppler early/late diastolic mitral inflow |
| Morphology of the left ventricles | 6-9 years of age | MRI assessment of the left ventricles morphology using cardiac statistical atlas and principal component analysis |
| Morphology of the right ventricles | 6-9 years of age | MRI assessment of the right ventricles morphology using cardiac statistical atlas and principal component analysis |
Other
| Measure | Time frame | Description |
|---|---|---|
| Endothelial colony forming cells (ECFC) colony formation | 6-9 years of age | Days for ECFC colony formation, measured in days |
| Endothelial colony forming cells (ECFC) proliferation rate | 6-9 years of age | ECFC proliferation rate, measured as a percentage |
| Subcortical brain volume of hippocampus | 6-9 years of age | Subcortical brain volume of hippocampus (in mm3) assessed on T1-weighted sequence of brain MRI |
| Subcortical brain volume of thalamus | 6-9 years of age | Subcortical brain volume of thalamus (in mm3) assessed on T1-weighted sequence of brain MRI |
| White matter hyperintensities count | 6-9 years of age | The number of white matter hyperintensities on T2-weighted sequence of brain MRI |
| White matter hyperintensities volume | 6-9 years of age | Total volume of white matter hyperintensities (in mm3) assessed on T2-weighted sequence of brain MRI |
| Cerebral vessel lumen diameter | 6-9 years of age | Cerebral vessel lumen diameter (in μm) assessed on the time-of-flight sequence of brain MRI |
| Cerebral vessel density | 6-9 years of age | Cerebral vessel density (in mm3) assessed on the time-of-flight sequence of brain MRI |
| Cerebral vessel tortuosity | 6-9 years of age | The ratio of cerebral vessel tortuosity assessed on the time-of-flight sequence of brain MRI |
| Whole brain grey matter perfusion or cerebral blood flow (CBF) | 6-9 years of age | Whole brain grey matter perfusion/CBF (in ml/100g/min) assessed on arterial spin labelling of brain MRI |
| Arterial cerebral blood volume fraction | 6-9 years of age | Arterial cerebral blood volume fraction (in %) assessed on arterial spin labelling of brain MRI |
| Endothelial colony forming cells (ECFC) branches formed | 6-9 years of age | The number of branches formed/1.5x10\^4 cells |
| Tube formation capacity in endothelial colony forming cells (ECFCs) | 6-9 years of age | The number of closed tubes formed/1.5x10\^4 cells |
Countries
United Kingdom
Outcome results
None listed