Low birth and heart failure in adulthood

Povezanost između niske porođajne težine (LBW, prema eng. Low Birth Weight) i kardiovaskularnih bolesti u odrasloj dobi jedna je od novijih intrigantnijih epidemioloških spoznaja. Hipertenzija, ateroskleroza, ishemijska bolest srca, pretilost i šećerna bolest djelomice su posljedica štetnih čimbenika prisutnih već u najranijem djetinjstvu. Podležeći mehanizam takve povezanosti još uvijek nije u potpunosti razjašnjen, no postoje brojne hipoteze, a dosada su istraživanjima potkrijepljene one o razvojnom programiranju i upali kao temeljnim patofiziološkim mehanizmima. Cilj ovog istraţivanja bio je uspostaviti povezanost između LBW i razvitka jedne od kardiomiopatija (CMP, prema eng. Cardiomyopathy) u odrasloj dobi koje vode zatajivanju srca, s naglaskom na nastanak dilatacijske CMP. Istraživanjem smo obuhvatili 7764 hospitaliziranih bolesnika u razdoblju od 2011. do 2013. godine, od kojih je izdvojeno 368 s dijagnozom jedne od CMP. Telefonskim intervjuom i uvidom u medicinsku dokumentaciju prikupili smo podatke o poroĊajnoj težini za 144 bolesnika. Prevalencija LBW u čitavoj skupini ispitanika podudara se s onom u općoj populaciji (8,3%) no valja istaknuti veći udio bolesnika s LBW unutar skupina kardiomiopatija sa sklonošću dilataciji lijeve klijetke (20% u skupini bolesnika s miokarditisom). Nadalje, bolesnici s preboljelim miokarditisom imali su u prosjeku najmanje porođajne težine (3144,1 ± 734,2 grama kod postmiokarditiĉne skupine i 3604,1 ± 835,6 grama u dilatacijske CMP, P=0.05). Navedene rezultate moguće je povezati s teorijom remodeliranja srca u fetalnoj dobi koja navodi razvoj lobularnih (dilatiranih) klijetki u fetusa s intrauterinim zaostajanjem u rastu i LBW. Prema našim rezultatima, posebno se istiĉe podskupina bolesnika s preboljelim miokarditisom koji imaju veći udio LBW i nižu prosječnu porođajnu težinu od ostalih CMP. Pretpostavljamo da ovi rezultati dijelom proizlaze i iz činjenice da bolesnici rođeni s LBW imaju i u odrasloj dobi sistemski upalni odgovor niskog stupnja koji predisponira nastanku miokarditisa. Ova studija pruža uvid u moguću povezanost LBW i pojedinih oblika kardiomiopatija te bi trebala bi biti osnova i poticaj za daljnja istraživanja na ovom području.Association between low birth weight (LBW) and cardiovascular diseases in adulthood is one of the more intriguing recent epidemiological discoveries. Hypertension, atherosclerosis, ischemic heart disease, obesity and diabetes are all partially due to harmful factors present from early childhood. The underlying pathophysiological mechanism remains unclear, altough there are several hypothesis from which two of them have been confirmed; developmental programming and the inflammantion theory. The aim of this research was to establish connection between LBW and development of cardiomyopathy (CMP) in adulthood which consequently leads to heart failure, with an emphasis on dilative CMP. Our study included 7764 patients hospitalized during the period from 2011 to 2013, out of which 368 diagnosed with one of the cardiomyopathies have been extracted. Birth weight data for 144 patients was collected through telephone interview and medical documentation. The prevalence of LBW in the studied group (8,3%) was similar to the one in the general population, but there were more LBW patients in the group of CMP with a tendency to left ventricular dilation (20% in the group of patients with myocarditis). Furthermore, the patients with history of myocarditis had on average lowest birth weights (3144,1 ± 734,2 grams in the postmyocarditis group and 3604,1 ± 835,6 grams in the dilative CMP one, P=0.05). The mentioned results might possibly be associated with the theory of heart remodeling during the fetal period, which suggests the development of globular (dilated) ventricles in fetuses with intrauterine growth restriction and LBW. According to our results, the group of patients with a history of myocarditis had a greater prevalence of LBW and lower average birth weight than the other CMP. We assume that these results are partially due to the fact that patients born with LBW have systemic low grade inflammation in adulthood which has a tendency to cause myocarditis. This study points out a possible association between LBW and particular form of cardiomyopathy in adulthood and it should serve as a basis for further investigations