Dilated hypertrophy: a distinct pattern of cardiac remodeling in preterm infants



Young adults born preterm have remodeled hearts, i.e., altered cardiac shape and size with impaired cardiac function. At present, the natural history and pattern of prematurity related cardiac remodeling are not clearly established. The aim of this study was to compare the left ventricle (LV) geometry and function of preterm infants at 36 weeks postmenstrual age (PMA) with gestation matched newborn infants.


LV end diastolic volume index (LV EDVI), LV mass index (LVMI), relative wall thickness (RWT), and sphericity index (SI) were prospectively obtained with echocardiography. LV geometry was classified according to the Gaasch method. LV function was assessed by determining ejection fraction (EF), longitudinal strain (LS), mitral annulus systolic motion (s’), and estimated LV filling pressure (E/e’).


Eighty-three preterm infants between 23 and 29 weeks gestation, and 40 infants of 36 weeks gestation at birth were analysed. LV EDVI, LVMI, SI, LS, s’, and E/e’ were higher in preterm group while RWT and EF were comparable between groups. LV showed normal geometry in 55.4%, physiological enlargement in 23% and dilated hypertrophy in 21.6% preterm infants.


At 36 week, preterm infants have significantly dilated, hypertrophied, and more spherical LV with impaired diastolic function compared with PMA matched newborn infants.

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The authors thank prof John Attia for his guidance on statistical analysis.

Author information




N.S.P. contributed to the study design, performed cardiac scans, collected and analysed data, and drafted the initial paper. K.W. contributed to study design, data collection, and revised the papers. C.H. and C.O. performed the statistical analysis and revised the paper.

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Correspondence to Nilkant S. Phad.

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Authors received John Hunter Hospital Charitable Trust research grant (2015) for this study. N. Phad also received the University of Newcastle research scholarship for this study.

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The authors declare no competing interests.

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Phad, N.S., de Waal, K., Holder, C. et al. Dilated hypertrophy: a distinct pattern of cardiac remodeling in preterm infants. Pediatr Res 87, 146–152 (2020). https://doi.org/10.1038/s41390-019-0568-4

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