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Roy J, Reynolds W, Panigrahy A, Ceschin R. Functional network organization is locally atypical in children and adolescents with congenital heart disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.19.24306106. [PMID: 38699341 PMCID: PMC11065028 DOI: 10.1101/2024.04.19.24306106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Children and adolescents with congenital heart disease (CHD) frequently experience neurodevelopmental impairments that can impact academic performance, memory, attention, and behavioral function, ultimately affecting overall quality of life. This study aims to investigate the impact of CHD on functional brain network connectivity and cognitive function. Using resting-state fMRI data, we examined several network metrics across various brain regions utilizing weighted networks and binarized networks with both absolute and proportional thresholds. Regression models were fitted to patient neurocognitive exam scores using various metrics obtained from all three methods. Our results unveil significant differences in network connectivity patterns, particularly in temporal, occipital, and subcortical regions, across both weighted and binarized networks. Furthermore, we identified distinct correlations between network metrics and cognitive performance, suggesting potential compensatory mechanisms within specific brain regions.
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Provost S, Fourdain S, Vannasing P, Tremblay J, Roger K, García-Puente Y, Doussau A, Vinay MC, Von Siebenthal Z, Paquette N, Poirier N, Gallagher A. Relationship between 4-month functional brain network topology and 24-month neurodevelopmental outcome in children with congenital heart disease. Eur J Paediatr Neurol 2023; 47:47-59. [PMID: 37729706 DOI: 10.1016/j.ejpn.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Survivors of complex forms of congenital heart disease (CHD)∗ are at high risk of neurodevelopmental disabilities. Neuroimaging studies have pointed to brain anomalies and immature networks in infants with CHD, yet less is known about their functional network topology and associations with neurodevelopment. To characterize the functional network topology in 4-month-old infants with repaired CHD, we compared graph theory metrics measured using resting-state functional near-infrared spectroscopy (rs-fNIRS) between infants with CHD (n = 22) and healthy controls (n = 30). We also investigated the moderating effect of graph theory metrics on the relationship between group (CHD vs. Controls) and developmental outcomes at 24 months. At 4 months, both groups presented similar functional brain network topology. At 24 months, children with CHD had lower scores on the language scale and the expressive communication subscale of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), as well as lower scores on the Grammatical Form scale of the MacArthur-Bates Communicative Development Inventory (MBCDI). The relationship between group and expressive language was moderated by the normalized characteristic path length (λ) and the degree (k). Although infants with CHD have functional brain topology similar to that of healthy controls, our findings suggest that they do not benefit from an optimal functional brain organization in comparison with healthy infants.
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Affiliation(s)
- Sarah Provost
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Solène Fourdain
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Phetsamone Vannasing
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Julie Tremblay
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Kassandra Roger
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | | | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | | | - Zorina Von Siebenthal
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Natacha Paquette
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Nancy Poirier
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Anne Gallagher
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.
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Lee VK, Wallace J, Meyers B, Racki A, Shah A, Beluk NH, Cabral L, Beers S, Badaly D, Lo C, Panigrahy A, Ceschin R. Cerebral Spinal Fluid Volumetrics and Paralimbic Predictors of Executive Dysfunction in Congenital Heart Disease: A Machine Learning Approach Informing Mechanistic Insights. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.16.23297055. [PMID: 37905005 PMCID: PMC10615017 DOI: 10.1101/2023.10.16.23297055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
The relationship between increased cerebral spinal fluid (CSF) ventricular compartments, structural and microstructural dysmaturation, and executive function in patients with congenital heart disease (CHD) is unknown. Here, we leverage a novel machine-learning data-driven technique to delineate interrelationships between CSF ventricular volume, structural and microstructural alterations, clinical risk factors, and sub-domains of executive dysfunction in adolescent CHD patients. We trained random forest regression models to predict measures of executive function (EF) from the NIH Toolbox, the Delis-Kaplan Executive Function System (D-KEFS), and the Behavior Rating Inventory of Executive Function (BRIEF) and across three subdomains of EF - mental flexibility, working memory, and inhibition. We estimated the best parameters for the random forest algorithm via a randomized grid search of parameters using 10-fold cross-validation on the training set only. The best parameters were then used to fit the model on the full training set and validated on the test set. Algorithm performance was measured using root-mean squared-error (RMSE). As predictors, we included patient clinical variables, perioperative clinical measures, microstructural white matter (diffusion tensor imaging- DTI), and structural volumes (volumetric magnetic resonance imaging- MRI). Structural white matter was measured using along-tract diffusivity measures of 13 inter-hemispheric and cortico-association fibers. Structural volumes were measured using FreeSurfer and manual segmentation of key structures. Variable importance was measured by the average Gini-impurity of each feature across all decision trees in which that feature is present in the model, and functional ontology mapping (FOM) was used to measure the degree of overlap in feature importance for each EF subdomain and across subdomains. We found that CSF structural properties (including increased lateral ventricular volume and reduced choroid plexus volumes) in conjunction with proximate cortical projection and paralimbic-related association white matter tracts that straddle the lateral ventricles and distal paralimbic-related subcortical structures (basal ganglia, hippocampus, cerebellum) are predictive of two-specific subdomains of executive dysfunction in CHD patients: cognitive flexibility and inhibition. These findings in conjunction with combined RF models that incorporated clinical risk factors, highlighted important clinical risk factors, including the presence of microbleeds, altered vessel volume, and delayed PDA closure, suggesting that CSF-interstitial fluid clearance, vascular pulsatility, and glymphatic microfluid dynamics may be pathways that are impaired in CHD, providing mechanistic information about the relationship between CSF and executive dysfunction.
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Affiliation(s)
- Vince K. Lee
- Department of Radiology, University of Pittsburgh School of Medicine
- Department of Bioengineering, University of Pittsburgh School of Medicine
| | - Julia Wallace
- Department of Radiology, University of Pittsburgh School of Medicine
| | - Benjamin Meyers
- Department of Radiology, University of Pittsburgh School of Medicine
| | - Adriana Racki
- Department of Radiology, University of Pittsburgh School of Medicine
| | - Anushka Shah
- Department of Radiology, University of Pittsburgh School of Medicine
| | - Nancy H. Beluk
- Department of Radiology, University of Pittsburgh School of Medicine
| | - Laura Cabral
- Department of Radiology, University of Pittsburgh School of Medicine
- Department of Biomedical Informatics, University of Pittsburgh
| | - Sue Beers
- Department of Psychiatry, University of Pittsburgh Medical Center
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Cecilia Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine
| | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh School of Medicine
- Department of Biomedical Informatics, University of Pittsburgh
| | - Rafael Ceschin
- Department of Radiology, University of Pittsburgh School of Medicine
- Department of Biomedical Informatics, University of Pittsburgh
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Panigrahy A, Schmithorst V, Ceschin R, Lee V, Beluk N, Wallace J, Wheaton O, Chenevert T, Qiu D, Lee JN, Nencka A, Gagoski B, Berman JI, Yuan W, Macgowan C, Coatsworth J, Fleysher L, Cannistraci C, Sleeper LA, Hoskoppal A, Silversides C, Radhakrishnan R, Markham L, Rhodes JF, Dugan LM, Brown N, Ermis P, Fuller S, Cotts TB, Rodriguez FH, Lindsay I, Beers S, Aizenstein H, Bellinger DC, Newburger JW, Umfleet LG, Cohen S, Zaidi A, Gurvitz M. Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note. J Cardiovasc Dev Dis 2023; 10:381. [PMID: 37754810 PMCID: PMC10532244 DOI: 10.3390/jcdd10090381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) "Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)". Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural-physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve.
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Affiliation(s)
- Ashok Panigrahy
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, 45th Str., Penn Ave., Pittsburgh, PA 15201, USA
| | - Vanessa Schmithorst
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Rafael Ceschin
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Vince Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Nancy Beluk
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Olivia Wheaton
- HealthCore Inc., 480 Pleasant Str., Watertown, MA 02472, USA;
| | - Thomas Chenevert
- Department of Radiology, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
- Congenital Heart Center, C. S. Mott Children’s Hospital, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322, USA;
| | - James N Lee
- Department of Radiology, The University of Utah, 50 2030 E, Salt Lake City, UT 84112, USA;
| | - Andrew Nencka
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Borjan Gagoski
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jeffrey I. Berman
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA;
- Department of Radiology, University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA
| | - Christopher Macgowan
- Department of Medical Biophysics, University of Toronto, 101 College Str. Suite 15-701, Toronto, ON M5G 1L7, Canada;
- The Hospital for Sick Children Division of Translational Medicine, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - James Coatsworth
- Department of Radiology, Medical University of South Carolina, 171 Ashley Ave., Room 372, Charleston, SC 29425, USA;
| | - Lazar Fleysher
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Christopher Cannistraci
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Arvind Hoskoppal
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Candice Silversides
- Department of Cardiology, University of Toronto, C. David Naylor Building, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada;
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 University Blvd., Indianapolis, IN 46202, USA;
| | - Larry Markham
- Department of Cardiology, University of Indiana School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA;
| | - John F. Rhodes
- Department of Cardiology, Medical University of South Carolina, 96 Jonathan Lucas Str. Ste. 601, MSC 617, Charleston, SC 29425, USA;
| | - Lauryn M. Dugan
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Nicole Brown
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Peter Ermis
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Stephanie Fuller
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Timothy Brett Cotts
- Departments of Internal Medicine and Pediatrics, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
| | - Fred Henry Rodriguez
- Department of Cardiology, Emory School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA;
| | - Ian Lindsay
- Department of Cardiology, The University of Utah, 95 S 2000 E, Salt Lake City, UT 84112, USA;
| | - Sue Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - David C. Bellinger
- Cardiac Neurodevelopmental Program, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Laura Glass Umfleet
- Department of Neuropsychology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Scott Cohen
- Heart and Vascular Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Ali Zaidi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
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Wu Y, Vasung L, Calixto C, Gholipour A, Karimi D. Characterizing normal perinatal development of the human brain structural connectivity. ARXIV 2023:arXiv:2308.11836v1. [PMID: 37664406 PMCID: PMC10473780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Early brain development is characterized by the formation of a highly organized structural connectome. The interconnected nature of this connectome underlies the brain's cognitive abilities and influences its response to diseases and environmental factors. Hence, quantitative assessment of structural connectivity in the perinatal stage is useful for studying normal and abnormal neurodevelopment. However, estimation of the connectome from diffusion MRI data involves complex computations. For the perinatal period, these computations are further challenged by the rapid brain development and imaging difficulties. Combined with high inter-subject variability, these factors make it difficult to chart the normal development of the structural connectome. As a result, there is a lack of reliable normative baselines of structural connectivity metrics at this critical stage in brain development. In this study, we developed a computational framework, based on spatio-temporal averaging, for determining such baselines. We used this framework to analyze the structural connectivity between 33 and 44 postmenstrual weeks using data from 166 subjects. Our results unveiled clear and strong trends in the development of structural connectivity in perinatal stage. Connection weighting based on fractional anisotropy and neurite density produced the most consistent results. We observed increases in global and local efficiency, a decrease in characteristic path length, and widespread strengthening of the connections within and across brain lobes and hemispheres. We also observed asymmetry patterns that were consistent between different connection weighting approaches. The new computational method and results are useful for assessing normal and abnormal development of the structural connectome early in life.
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Affiliation(s)
- Yihan Wu
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, USA
| | - Lana Vasung
- Department of Pediatrics at Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Camilo Calixto
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, USA
| | - Ali Gholipour
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, USA
| | - Davood Karimi
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, USA
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Sahel A, Ceschin R, Badaly D, Lewis M, Lee VK, Wallace J, Weinberg J, Schmithorst V, Lo C, Panigrahy A. Increased Cerebello-Prefrontal Connectivity Predicts Poor Executive Function in Congenital Heart Disease. J Clin Med 2023; 12:5264. [PMID: 37629306 PMCID: PMC10455623 DOI: 10.3390/jcm12165264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Children and adolescents with congenital heart disease (CHD) are at risk for cognitive impairments, such as executive function deficits and motor delays, which can impact their academic and adaptive functioning as well as their quality of life. We investigated whether alterations in connectivity between the prefrontal and cerebellar brain structures exist between CHD and control cohorts and if these alterations could predict cognitive or motor impairment among youths with CHD. METHODS 53 participants with CHD and 73 healthy control participants completed multi-modal magnetic resonance imaging (MRI) of the brain, including high-resolution diffusion tensor imaging at 3T. We measured connectivity from masked regions of interest in the cerebellum to the frontal cortex using a probabilistic tractography method. Participants also completed neuropsychological tests of cognitive and motor skills using the NIH Toolbox. RESULTS In the CHD group, fractional anisotropy (FA) was increased in the cognitive loop connectivity pathways, including from the right cerebellum to the left thalamus (p = 0.0002) and from the left thalamus to the left medial frontal gyrus (MFG) (p = 0.0048) compared with the healthy control group. In contrast, there were no differences between CHD and controls in motor loop connectivity pathways. An increase in FA from the right thalamus to the MFG tract in the cognitive loop (posterior subdivision) predicted (p = 0.03) lower scores on the NIHTB tests, including those of executive functioning. A transient increase in connectivity of the cognitive loop in the adolescent group was observed relative to the child and adult groups. CONCLUSIONS Our results suggest that selective alteration of cerebellum-cerebral connectivity circuitry within the cognitive loops predicts cognitive dysfunction in CHD youth. Our study suggests a critical period of cerebellar circuitry plasticity in the adolescent period in CHD subjects that drives neurocognitive function. Further replication and validation in other pediatric CHD cohorts is warranted for future work.
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Affiliation(s)
- Aurelia Sahel
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.S.); (R.C.); (M.L.); (V.K.L.); (J.W.); (V.S.)
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Rafael Ceschin
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.S.); (R.C.); (M.L.); (V.K.L.); (J.W.); (V.S.)
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | | | - Madison Lewis
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.S.); (R.C.); (M.L.); (V.K.L.); (J.W.); (V.S.)
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Vince K. Lee
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.S.); (R.C.); (M.L.); (V.K.L.); (J.W.); (V.S.)
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Julia Wallace
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.S.); (R.C.); (M.L.); (V.K.L.); (J.W.); (V.S.)
| | - Jacqueline Weinberg
- Department of Cardiology, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Vanessa Schmithorst
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.S.); (R.C.); (M.L.); (V.K.L.); (J.W.); (V.S.)
| | - Cecilia Lo
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA 15201, USA;
| | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.S.); (R.C.); (M.L.); (V.K.L.); (J.W.); (V.S.)
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, 45th Street and 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Merkel CA, Brady KM, Votava-Smith JK, Tran NN. A pilot study: Comparing a novel noninvasive measure of cerebrovascular stability index with an invasive measure of cerebral autoregulation in neonates with congenital heart disease. J Clin Transl Sci 2023; 7:e165. [PMID: 37588677 PMCID: PMC10425865 DOI: 10.1017/cts.2023.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 08/18/2023] Open
Abstract
Infants with congenital heart disease (CHD) may have impaired cerebral autoregulation (CA) associated with cerebral fractional tissue oxygen extraction (FTOE). We conducted a pilot study in nine CHD neonates to validate a noninvasive CA measure, cerebrovascular stability index (CSI), by eliciting responses to postural tilts. We compared CSI to an invasive measure of CA and to FTOE collected during tilts (FTOESpot). FTOESpot correlated with CSI, as did the change in FTOE during tilts, but CSI's correlation with impaired CA did not reach significance. Larger trials are indicated to validate CSI, allowing for noninvasive CA measurements and measurements in outpatient settings.
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Affiliation(s)
| | - Kenneth M. Brady
- Division of Cardiac Anesthesia, Northwestern University Feinberg School of Medicine and Ann & Robert H, Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Jodie K. Votava-Smith
- Keck School of Medicine, Los Angeles, CA, USA
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Nhu N. Tran
- Keck School of Medicine, Los Angeles, CA, USA
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Schmithorst V, Ceschin R, Lee V, Wallace J, Sahel A, Chenevert TL, Parmar H, Berman JI, Vossough A, Qiu D, Kadom N, Grant PE, Gagoski B, LaViolette PS, Maheshwari M, Sleeper LA, Bellinger DC, Ilardi D, O’Neil S, Miller TA, Detterich J, Hill KD, Atz AM, Richmond ME, Cnota J, Mahle WT, Ghanayem NS, Gaynor JW, Goldberg CS, Newburger JW, Panigrahy A. Single Ventricle Reconstruction III: Brain Connectome and Neurodevelopmental Outcomes: Design, Recruitment, and Technical Challenges of a Multicenter, Observational Neuroimaging Study. Diagnostics (Basel) 2023; 13:1604. [PMID: 37174995 PMCID: PMC10178603 DOI: 10.3390/diagnostics13091604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Patients with hypoplastic left heart syndrome who have been palliated with the Fontan procedure are at risk for adverse neurodevelopmental outcomes, lower quality of life, and reduced employability. We describe the methods (including quality assurance and quality control protocols) and challenges of a multi-center observational ancillary study, SVRIII (Single Ventricle Reconstruction Trial) Brain Connectome. Our original goal was to obtain advanced neuroimaging (Diffusion Tensor Imaging and Resting-BOLD) in 140 SVR III participants and 100 healthy controls for brain connectome analyses. Linear regression and mediation statistical methods will be used to analyze associations of brain connectome measures with neurocognitive measures and clinical risk factors. Initial recruitment challenges occurred that were related to difficulties with: (1) coordinating brain MRI for participants already undergoing extensive testing in the parent study, and (2) recruiting healthy control subjects. The COVID-19 pandemic negatively affected enrollment late in the study. Enrollment challenges were addressed by: (1) adding additional study sites, (2) increasing the frequency of meetings with site coordinators, and (3) developing additional healthy control recruitment strategies, including using research registries and advertising the study to community-based groups. Technical challenges that emerged early in the study were related to the acquisition, harmonization, and transfer of neuroimages. These hurdles were successfully overcome with protocol modifications and frequent site visits that involved human and synthetic phantoms.
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Affiliation(s)
- Vanessa Schmithorst
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Floor 2, Pittsburgh, PA 15224, USA
| | - Rafael Ceschin
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Floor 2, Pittsburgh, PA 15224, USA
- Department of Biomedical Informatics, University of Pittsburgh School, 5607 Baum Blvd., Pittsburgh, PA 15206, USA
| | - Vincent Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Floor 2, Pittsburgh, PA 15224, USA
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Floor 2, Pittsburgh, PA 15224, USA
| | - Aurelia Sahel
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Floor 2, Pittsburgh, PA 15224, USA
| | - Thomas L. Chenevert
- Michigan Medicine Department of Radiology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Hemant Parmar
- Michigan Medicine Department of Radiology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Jeffrey I. Berman
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Arastoo Vossough
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Children’s Healthcare of Atlanta, Emory University, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Children’s Healthcare of Atlanta, Emory University, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Patricia Ellen Grant
- Children’s Hospital Boston, Fetal-Neonatal Neuroimaging and Developmental Science Center (FNNDSC), 300 Longwood Avenue, Boston, MA 02115, USA
| | - Borjan Gagoski
- Department of Radiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Peter S. LaViolette
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - David C. Bellinger
- Cardiac Neurodevelopmental Program, Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Dawn Ilardi
- Department of Neuropsychology, Children’s Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA 30329, USA
| | - Sharon O’Neil
- Children’s Hospital Los Angeles, Neuropsychology Core of the Saban Research Institute, 4661 Sunset Blvd., Los Angeles, CA 90027, USA
| | - Thomas A. Miller
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Jon Detterich
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA
| | - Kevin D. Hill
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, 7506 Hospital North, DUMC Box 3090, Durham, NC 27710, USA
| | - Andrew M. Atz
- Division of Pediatric Cardiology, Medical University of South Carolina, 96 Jonathan Lucas St. Ste. 601, MSC 617, Charleston, SC 29425, USA
| | - Marc E. Richmond
- Program for Pediatric Cardiomyopathy, Heart Failure, and Transplantation, New York-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway MSCH North, 2nd Floor, New York, NY 10032, USA
| | - James Cnota
- Fetal Heart Program, Cincinnati Children’s, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - William T. Mahle
- Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, 1400 Tullie Rd NE Suite 630, Atlanta, GA 30329, USA
| | - Nancy S. Ghanayem
- Section of Pediatric Critical Care, Department of Pediatrics, Comer Children’s Hospital, University of Chicago Medicine, 5721 S. Maryland Avenue, Chicago, IL 60637, USA
- Department of Pediatrics, Medical College of Wisconsin Section of Pediatric Critical Care, 9000 W. Wisconsin Avenue MS 681, Milwaukee, WI 53226, USA
| | - J. William Gaynor
- Heart Failure and Transplant Program, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Caren S. Goldberg
- Department of Pediatrics, Division of Cardiology, C.S. Mott Children’s Hospital, 1540 E Hospital Dr #4204, Ann Arbor, MI 48109, USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Ashok Panigrahy
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Floor 2, Pittsburgh, PA 15224, USA
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9
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Schmithorst V, Ceschin R, Lee V, Wallace J, Sahel A, Chenevert T, Parmar H, Berman JI, Vossough A, Qiu D, Kadom N, Grant PE, Gagoski B, LaViolette P, Maheshwari M, Sleeper LA, Bellinger D, Ilardi D, O’Neil S, Miller TA, Detterich J, Hill KD, Atz AM, Richmond M, Cnota J, Mahle WT, Ghanayem N, Gaynor W, Goldberg CS, Newburger JW, Panigrahy A. Single Ventricle Reconstruction III: Brain Connectome and Neurodevelopmental Outcomes: Design, Recruitment, and Technical Challenges of a Multicenter, Observational Neuroimaging Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.12.23288433. [PMID: 37131744 PMCID: PMC10153324 DOI: 10.1101/2023.04.12.23288433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Patients with hypoplastic left heart syndrome who have been palliated with the Fontan procedure are at risk for adverse neurodevelopmental outcomes, lower quality of life, and reduced employability. We describe the methods (including quality assurance and quality control protocols) and challenges of a multi-center observational ancillary study, SVRIII (Single Ventricle Reconstruction Trial) Brain Connectome. Our original goal was to obtain advanced neuroimaging (Diffusion Tensor Imaging and Resting-BOLD) in 140 SVR III participants and 100 healthy controls for brain connectome analyses. Linear regression and mediation statistical methods will be used to analyze associations of brain connectome measures with neurocognitive measures and clinical risk factors. Initial recruitment challenges occurred related to difficulties with: 1) coordinating brain MRI for participants already undergoing extensive testing in the parent study, and 2) recruiting healthy control subjects. The COVID-19 pandemic negatively affected enrollment late in the study. Enrollment challenges were addressed by 1) adding additional study sites, 2) increasing the frequency of meetings with site coordinators and 3) developing additional healthy control recruitment strategies, including using research registries and advertising the study to community-based groups. Technical challenges that emerged early in the study were related to the acquisition, harmonization, and transfer of neuroimages. These hurdles were successfully overcome with protocol modifications and frequent site visits that involved human and synthetic phantoms. Trial registration number ClinicalTrials.gov Registration Number: NCT02692443.
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Affiliation(s)
- Vanessa Schmithorst
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Floor 2, Pittsburgh, PA 15224 USA
| | - Rafael Ceschin
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Floor 2, Pittsburgh, PA 15224 USA
- Department of Biomedical Informatics, University of Pittsburgh School, 5607 Baum Blvd, Pittsburgh, PA 15206-3701 USA
| | - Vince Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Floor 2, Pittsburgh, PA 15224 USA
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Floor 2, Pittsburgh, PA 15224 USA
| | - Aurelia Sahel
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Floor 2, Pittsburgh, PA 15224 USA
| | - Thomas Chenevert
- Department of Radiology, Michigan Medicine, University of Michigan, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Hemant Parmar
- Department of Radiology, Michigan Medicine, University of Michigan, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Jeffrey I. Berman
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Arastoo Vossough
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Children’s Healthcare of Atlanta, Emory University, 1364 Clifton Rd, Atlanta, GA 30322 USA
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Children’s Healthcare of Atlanta, Emory University, 1364 Clifton Rd, Atlanta, GA 30322 USA
| | - Patricia Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Borjan Gagoski
- Department of Radiology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 USA
| | - Peter LaViolette
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226 USA
| | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226 USA
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115
- Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - David Bellinger
- Cardiac Neurodevelopmental Program, Department of Neurology, Boston, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Dawn Ilardi
- Department of Neuropsychology, Children’s Healthcare of Atlanta, 1400 Tullie Road NE, Atlanta, GA 30329
| | - Sharon O’Neil
- Neuropsychology Core of the Saban Research Institute, Children’s Hospital Los Angeles, 4661 Sunset Blvd., Los Angeles, CA 90027 USA
| | - Thomas A. Miller
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132 USA
| | - Jon Detterich
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027 USA
| | - Kevin D. Hill
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University, School of Medicine, 7506 Hospital North, DUMC Box 3090, Durham, NC 27710 USA
| | - Andrew M. Atz
- Division of Pediatric Cardiology, Medical University of South Carolina, 96 Jonathan Lucas St. Ste. 601, MSC 617, Charleston, SC 29425 USA
| | - Marc Richmond
- Program for Pediatric Cardiomyopathy, Heart Failure, and Transplantation, New York-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway MSCH North, 2 Floor, New York, NY 10032 USA
| | - James Cnota
- Fetal Heart Program, Cincinnati Children’s, 3333 Burnet Avenue, Cincinnati, Ohio 45229-3026 USA
| | - William T. Mahle
- Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, 1400 Tullie Rd NE Suite 630, Atlanta, GA 30329
| | - Nancy Ghanayem
- Section of Pediatric Critical Care, Department of Pediatrics, University of Chicago Medicine, Comer Children’s Hospital, 5721 S. Maryland Ave., Chicago, IL 60637 USA
- Section of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Ave. MS 681, Milwaukee, WI 53226 USA
| | - William Gaynor
- Heart Failure and Transplant Program, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - Caren S. Goldberg
- Department of Pediatrics, Division of Cardiology, C.S. Mott Children’s Hospital, 1540 E Hospital Dr #4204, Ann Arbor, MI 48109 USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Ashok Panigrahy
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Floor 2, Pittsburgh, PA 15224 USA
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10
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Brossard-Racine M, Panigrahy A. Structural Brain Alterations and Their Associations With Function in Children, Adolescents, and Young Adults With Congenital Heart Disease. Can J Cardiol 2023; 39:123-132. [PMID: 36336305 DOI: 10.1016/j.cjca.2022.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/06/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Most neonates who receive surgery for complex congenital heart disease (CHD) will survive well into adulthood, however, many of them will face functional challenges at one point during their life as a consequence of their atypical neurodevelopment. Recent advances in neuroscience and the increasing accessibility of magnetic resonance imaging have allowed numerous studies to identify the nature and extent of the brain alterations that are particular to survivors with CHD. Nevertheless, and considering that the range of outcomes is broad in this population, the functional consequences of these brain differences is not always evident. In this review, we summarize the present state of knowledge regarding the structure-function relationships evaluated in children, adolescents, and young adults with CHD using structural magnetic resonance imaging. Overall smaller total and regional brain volume, as well as lower fractional anisotropy in numerous brain regions, were frequently associated with lower cognitive outcomes including executive functioning and memory in adolescents and young adults with CHD. However, we identify several gaps in knowledge including the limited number of prospective investigations involving neonatal imaging and follow-up during childhood or adolescence, as well as the need for studies that evaluate a broader range of functional outcomes and not only the cognitive abilities. Future interdisciplinary investigations using multimodal imaging techniques could help address these gaps.
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Affiliation(s)
- Marie Brossard-Racine
- Advances in Brain and Child Development Research Laboratory, Research Institute of McGill University Health Center - Child Heald and Human Development, and School of Physical and Occupational Therapy, Department of Pediatrics - Division of Neonatology and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Ashok Panigrahy
- Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, and Clinical and Translational Imaging Research, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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11
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Williamson BJ, Barnes-Davis ME, Vannest J, Anixt JS, Heydarian HC, Kuan L, Laue CS, Pratap J, Schapiro M, Tseng SY, Kadis DS. Altered white matter connectivity in children with congenital heart disease with single ventricle physiology. Sci Rep 2023; 13:1318. [PMID: 36693986 PMCID: PMC9873737 DOI: 10.1038/s41598-023-28634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Children born with congenital heart disease (CHD) have seen a dramatic decrease in mortality thanks to surgical innovations. However, there are numerous risk factors associated with CHD that can disrupt neurodevelopment. Recent studies have found that psychological deficits and structural brain abnormalities persist into adulthood. The goal of the current study was to investigate white matter connectivity in early school-age children (6-11 years), born with complex cyanotic CHD (single ventricle physiology), who have undergone Fontan palliation, compared to a group of heart-healthy, typically developing controls (TPC). Additionally, we investigated associations between white matter tract connectivity and measures on a comprehensive neuropsychological battery within each group. Our results suggest CHD patients exhibit widespread decreases in white matter connectivity, and the extent of these decreases is related to performance in several cognitive domains. Analysis of network topology showed that hub distribution was more extensive and bilateral in the TPC group. Our results are consistent with previous studies suggesting perinatal ischemia leads to white matter lesions and delayed maturation.
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Affiliation(s)
| | - Maria E Barnes-Davis
- Department of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Julia S Anixt
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Haleh C Heydarian
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa Kuan
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cameron S Laue
- Department Psychology, Pacific University, Forest Grove, OR, USA
| | - Jayant Pratap
- Divisions of Cardiac Anesthesia and Cardiac Critical Care Medicine, Department of Anesthesia and Critical Care Medicine and Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark Schapiro
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Darren S Kadis
- Neurosciences and Mental Health, Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. .,Department of Physiology, University of Toronto, Toronto, ON, Canada.
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12
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Votava-Smith JK, Gaesser J, Harbison AL, Lee V, Tran N, Rajagopalan V, del Castillo S, Kumar SR, Herrup E, Baust T, Johnson JA, Gabriel GC, Reynolds WT, Wallace J, Meyers B, Ceschin R, Lo CW, Schmithorst VJ, Panigrahy A. Clinical factors associated with microstructural connectome related brain dysmaturation in term neonates with congenital heart disease. Front Neurosci 2022; 16:952355. [PMID: 36466162 PMCID: PMC9717392 DOI: 10.3389/fnins.2022.952355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Term congenital heart disease (CHD) neonates display abnormalities of brain structure and maturation, which are possibly related to underlying patient factors, abnormal physiology and perioperative insults. Our primary goal was to delineate associations between clinical factors and postnatal brain microstructure in term CHD neonates using diffusion tensor imaging (DTI) magnetic resonance (MR) acquisition combined with complementary data-driven connectome and seed-based tractography quantitative analyses. Our secondary goal was to delineate associations between mild dysplastic structural brain abnormalities and connectome and seed-base tractography quantitative analyses. These mild dysplastic structural abnormalities have been derived from prior human infant CHD MR studies and neonatal mouse models of CHD that were collectively used to calculate to calculate a brain dysplasia score (BDS) that included assessment of subcortical structures including the olfactory bulb, the cerebellum and the hippocampus. Methods Neonates undergoing cardiac surgery for CHD were prospectively recruited from two large centers. Both pre- and postoperative MR brain scans were obtained. DTI in 42 directions was segmented into 90 regions using a neonatal brain template and three weighted methods. Clinical data collection included 18 patient-specific and 9 preoperative variables associated with preoperative scan and 6 intraoperative (e.g., cardiopulmonary bypass and deep hypothermic circulatory arrest times) and 12 postoperative variables associated with postoperative scan. We compared patient specific and preoperative clinical factors to network topology and tractography alterations on a preoperative neonatal brain MRI, and intra and postoperative clinical factors to network topology alterations on postoperative neonatal brain MRI. A composite BDS was created to score abnormal findings involving the cerebellar hemispheres and vermis, supratentorial extra-axial fluid, olfactory bulbs and sulci, hippocampus, choroid plexus, corpus callosum, and brainstem. The neuroimaging outcomes of this study included (1) connectome metrics: cost (number of connections) and global/nodal efficiency (network integration); (2) seed based tractography methods of fractional anisotropy (FA), radial diffusivity, and axial diffusivity. Statistics consisted of multiple regression with false discovery rate correction (FDR) comparing the clinical risk factors and BDS (including subcortical components) as predictors/exposures and the global connectome metrics, nodal efficiency, and seed based- tractography (FA, radial diffusivity, and axial diffusivity) as neuroimaging outcome measures. Results A total of 133 term neonates with complex CHD were prospectively enrolled and 110 had analyzable DTI. Multiple patient-specific factors including d-transposition of the great arteries (d-TGA) physiology and severity of impairment of fetal cerebral substrate delivery (i.e., how much the CHD lesion alters typical fetal circulation such that the highest oxygen and nutrient rich blood from the placenta are not directed toward the fetal brain) were predictive of preoperative reduced cost (p < 0.0073) and reduced global/nodal efficiency (p < 0.03). Cardiopulmonary bypass time predicted postoperative reduced cost (p < 0.04) and multiple postoperative factors [extracorporeal membrane oxygenation (ECMO), seizures and cardiopulmonary resuscitation (CPR)] were predictive of postoperative reduced cost and reduced global/nodal efficiency (p < 0.05). Anthropometric measurements (weight, length, and head size) predicted tractography outcomes. Total BDS was not predictive of brain network topology. However, key subcortical components of the BDS score did predict key global and nodal network topology: abnormalities of the cerebellum predicted reduced cost (p < 0.0417) and of the hippocampus predicted reduced global efficiency (p < 0.0126). All three subcortical structures predicted unique alterations of nodal efficiency (p < 0.05), including hippocampal abnormalities predicting widespread reduced nodal efficiency in all lobes of the brain, cerebellar abnormalities predicting increased prefrontal nodal efficiency, and olfactory bulb abnormalities predicting posterior parietal-occipital nodal efficiency. Conclusion Patient-specific (d-TGA anatomy, preoperative impairment of fetal cerebral substrate delivery) and postoperative (e.g., seizures, need for ECMO, or CPR) clinical factors were most predictive of diffuse postnatal microstructural dysmaturation in term CHD neonates. Anthropometric measurements (weight, length, and head size) predicted tractography outcomes. In contrast, subcortical components (cerebellum, hippocampus, olfactory) of a structurally based BDS (derived from CHD mouse mutants), predicted more localized and regional postnatal microstructural differences. Collectively, these findings suggest that brain DTI connectome and seed-based tractography are complementary techniques which may facilitate deciphering the mechanistic relative contribution of clinical and genetic risk factors related to poor neurodevelopmental outcomes in CHD.
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Affiliation(s)
- Jodie K. Votava-Smith
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Jenna Gaesser
- Department of Neurology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Vince Lee
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Nhu Tran
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine of USC, Children’s Hospital Los Angeles, Fetal and Neonatal Institute, Los Angeles, CA, United States
| | - Vidya Rajagopalan
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Sylvia del Castillo
- Department of Anesthesiology Critical Care Medicine Anesthesiology, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - S. Ram Kumar
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Elizabeth Herrup
- Division of Pediatric Cardiac Intensive Care, Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tracy Baust
- Division of Pediatric Cardiac Intensive Care, Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jennifer A. Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - George C. Gabriel
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - William T. Reynolds
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Julia Wallace
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Benjamin Meyers
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rafael Ceschin
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cecilia W. Lo
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Vanessa J. Schmithorst
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States,*Correspondence: Ashok Panigrahy,
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13
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Tran NN, Tran M, Panigrahy A, Brady KM, Votava-Smith JK. Association of Cerebrovascular Stability Index and Head Circumference Between Infants With and Without Congenital Heart Disease. Pediatr Cardiol 2022; 43:1624-1630. [PMID: 35426499 DOI: 10.1007/s00246-022-02891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
Congenital heart disease (CHD) is a common birth defect in the United States. CHD infants are more likely to have smaller head circumference and neurodevelopmental delays; however, the cause is unknown. Altered cerebrovascular hemodynamics may contribute to neurologic abnormalities, such as smaller head circumference, thus we created a novel Cerebrovascular Stability Index (CSI), as a surrogate for cerebral autoregulation. We hypothesized that CHD infants would have an association between CSI and head circumference. We performed a prospective, longitudinal study in CHD infants and healthy controls. We measured CSI and head circumference at 4 time points (newborn, 3, 6, 9 months). We calculated CSI by subtracting the average 2-min sitting from supine cerebral oxygenation (rcSO2) over three consecutive tilts (0-90°), then averaged the change score for each age. Linear regressions quantified the relationship between CSI and head circumference. We performed 177 assessments in total (80 healthy controls, 97 CHD infants). The average head circumference was smaller in CHD infants (39.2 cm) compared to healthy controls (41.6 cm) (p < 0.001) and head circumference increased by 0.27 cm as CSI improved in the sample (p = 0.04) overall when combining all time points. Similarly, head circumference increased by 0.32 cm as CSI improved among CHD infants (p = 0.04). We found CSI significantly associated with head circumference in our sample overall and CHD infants alone, which suggests that impaired CSI may affect brain size in CHD infants. Future studies are needed to better understand the mechanism of interaction between CSI and brain growth.
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Affiliation(s)
- Nhu N Tran
- Division of Neonatology, Children's Hospital Los Angeles (CHLA), Fetal and Neonatal Institute, 4650 Sunset Blvd., MS#137, Los Angeles, CA, 90027, USA. .,Department of Pediatrics, Keck School of Medicine, University of Southern California (KSOM USC), Los Angeles, CA, USA.
| | - Michelle Tran
- Department of Population and Public Health Sciences, KSOM USC, Los Angeles, CA, USA.,Division of Research on Children, Youth, and Families, The Saban Research Institute, CHLA, Los Angeles, CA, USA
| | - Ashok Panigrahy
- Department of Pediatric Radiology, CHLA, Los Angeles, CA, USA.,University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ken M Brady
- Lurie Children's Hospital of Chicago, Anesthesiology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jodie K Votava-Smith
- Department of Pediatrics, Keck School of Medicine, University of Southern California (KSOM USC), Los Angeles, CA, USA.,Division of Cardiology, Department of Pediatrics, CHLA and KSOM USC, Los Angeles, CA, USA
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14
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Meyers B, Lee VK, Dennis L, Wallace J, Schmithorst V, Votava-Smith JK, Rajagopalan V, Herrup E, Baust T, Tran NN, Hunter J, Licht DJ, Gaynor JW, Andropoulos DB, Panigrahy A, Ceschin R. Harmonization of Multi-Center Diffusion Tensor Tractography in Neonates with Congenital Heart Disease: Optimizing Post-Processing and Application of ComBat. NEUROIMAGE. REPORTS 2022; 2:100114. [PMID: 36258783 PMCID: PMC9575513 DOI: 10.1016/j.ynirp.2022.100114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Advanced brain imaging of neonatal macrostructure and microstructure, which has prognosticating importance, is more frequently being incorporated into multi-center trials of neonatal neuroprotection. Multicenter neuroimaging studies, designed to overcome small sample sized clinical cohorts, are essential but lead to increased technical variability. Few harmonization techniques have been developed for neonatal brain microstructural (diffusion tensor) analysis. The work presented here aims to remedy two common problems that exist with the current state of the art approaches: 1) variance in scanner and protocol in data collection can limit the researcher's ability to harmonize data acquired under different conditions or using different clinical populations. 2) The general lack of objective guidelines for dealing with anatomically abnormal anatomy and pathology. Often, subjects are excluded due to subjective criteria, or due to pathology that could be informative to the final analysis, leading to the loss of reproducibility and statistical power. This proves to be a barrier in the analysis of large multi-center studies and is a particularly salient problem given the relative scarcity of neonatal imaging data. We provide an objective, data-driven, and semi-automated neonatal processing pipeline designed to harmonize compartmentalized variant data acquired under different parameters. This is done by first implementing a search space reduction step of extracting the along-tract diffusivity values along each tract of interest, rather than performing whole-brain harmonization. This is followed by a data-driven outlier detection step, with the purpose of removing unwanted noise and outliers from the final harmonization. We then use an empirical Bayes harmonization algorithm performed at the along-tract level, with the output being a lower dimensional space but still spatially informative. After applying our pipeline to this large multi-site dataset of neonates and infants with congenital heart disease (n= 398 subjects recruited across 4 centers, with a total of n=763 MRI pre-operative/post-operative time points), we show that infants with single ventricle cardiac physiology demonstrate greater white matter microstructural alterations compared to infants with bi-ventricular heart disease, supporting what has previously been shown in literature. Our method is an open-source pipeline for delineating white matter tracts in subject space but provides the necessary modular components for performing atlas space analysis. As such, we validate and introduce Diffusion Imaging of Neonates by Group Organization (DINGO), a high-level, semi-automated framework that can facilitate harmonization of subject-space tractography generated from diffusion tensor imaging acquired across varying scanners, institutions, and clinical populations. Datasets acquired using varying protocols or cohorts are compartmentalized into subsets, where a cohort-specific template is generated, allowing for the propagation of the tractography mask set with higher spatial specificity. Taken together, this pipeline can reduce multi-scanner technical variability which can confound important biological variability in relation to neonatal brain microstructure.
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Affiliation(s)
- Benjamin Meyers
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Vincent K. Lee
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Lauren Dennis
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Julia Wallace
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Vanessa Schmithorst
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jodie K. Votava-Smith
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Los Angeles and Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Vidya Rajagopalan
- Department of Radiology, Children’s Hospital of Los Angeles and Keck School of Medicine University of Southern California Los Angeles, CA
| | - Elizabeth Herrup
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Tracy Baust
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Nhu N. Tran
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Los Angeles and Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Jill Hunter
- Department of Radiology, Texas Children’s Hospital, Houston, TX
| | - Daniel J. Licht
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - J. William Gaynor
- Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rafael Ceschin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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15
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Bonthrone AF, Chew A, Bhroin MN, Rech FM, Kelly CJ, Christiaens D, Pietsch M, Tournier JD, Cordero-Grande L, Price A, Egloff A, Hajnal JV, Pushparajah K, Simpson J, David Edwards A, Rutherford MA, Nosarti C, Batalle D, Counsell SJ. Neonatal frontal-limbic connectivity is associated with externalizing behaviours in toddlers with Congenital Heart Disease. Neuroimage Clin 2022; 36:103153. [PMID: 35987179 PMCID: PMC9403726 DOI: 10.1016/j.nicl.2022.103153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Children with Congenital Heart Disease (CHD) are at increased risk of neurodevelopmental impairments. The neonatal antecedents of impaired behavioural development are unknown. 43 infants with CHD underwent presurgical brain diffusion-weighted MRI [postmenstrual age at scan median (IQR) = 39.29 (38.71-39.71) weeks] and a follow-up assessment at median age of 22.1 (IQR 22.0-22.7) months in which parents reported internalizing and externalizing problem scores on the Child Behaviour Checklist. We constructed structural brain networks from diffusion-weighted MRI and calculated edge-wise structural connectivity as well as global and local brain network features. We also calculated presurgical cerebral oxygen delivery, and extracted perioperative variables, socioeconomic status at birth and a measure of cognitively stimulating parenting. Lower degree in the right inferior frontal gyrus (partial ρ = -0.687, p < 0.001) and reduced connectivity in a frontal-limbic sub-network including the right inferior frontal gyrus were associated with higher externalizing problem scores. Externalizing problem scores were unrelated to neonatal clinical course or home environment. However, higher internalizing problem scores were associated with earlier surgery in the neonatal period (partial ρ = -0.538, p = 0.014). Our results highlight the importance of frontal-limbic networks to the development of externalizing behaviours and provide new insights into early antecedents of behavioural impairments in CHD.
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Affiliation(s)
- Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Megan Ní Bhroin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Francesca Morassutti Rech
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Electrical Engineering (ESAT/PSI), KU Leuven, Leuven, Belgium
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kuberan Pushparajah
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - John Simpson
- Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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16
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Reduced Cerebellar Volume in Term Infants with Complex Congenital Heart Disease: Correlation with Postnatal Growth Measurements. Diagnostics (Basel) 2022; 12:diagnostics12071644. [PMID: 35885549 PMCID: PMC9321214 DOI: 10.3390/diagnostics12071644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 11/16/2022] Open
Abstract
Aberrant cerebellar development and the associated neurocognitive deficits has been postulated in infants with congenital heart disease (CHD). Our objective is to investigate the effect of postnatal head and somatic growth on cerebellar development in neonates with CHD. We compared term-born neonates with a history of CHD with a cohort of preterm-born neonates, two cohorts at similar risk for neurodevelopment impairment, in order to determine if they are similarly affected in the early developmental period. Study Design: 51 preterms-born healthy neonates, 62 term-born CHD neonates, and 54 term-born healthy neonates underwent a brain MRI with volumetric imaging. Cerebellar volumes were extracted through an automated segmentation pipeline that was developed in-house. Volumes were correlated with clinical growth parameters at both the birth and time of MRI. Results: The CHD cohort showed significantly lower cerebellar volumes when compared with both the control (p < 0.015) and preterm (p < 0.004) groups. Change in weight from birth to time of MRI showed a moderately strong correlation with cerebellar volume at time of MRI (r = 0.437, p < 0.002) in the preterms, but not in the CHD neonates (r = 0.205, p < 0.116). Changes in birth length and head circumference showed no significant correlation with cerebellar volume at time of MRI in either cohort. Conclusions: Cerebellar development in premature-born infants is associated with change in birth weight in the early post-natal period. This association is not observed in term-born neonates with CHD, suggesting differential mechanisms of aberrant cerebellar development in these perinatal at-risk populations.
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17
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Neonatal brain injury influences structural connectivity and childhood functional outcomes. PLoS One 2022; 17:e0262310. [PMID: 34986206 PMCID: PMC8730412 DOI: 10.1371/journal.pone.0262310] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
Neonatal brain injury may impact brain development and lead to lifelong functional impairments. Hypoxic-ischemic encephalopathy (HIE) and congenital heart disease (CHD) are two common causes of neonatal brain injury differing in timing and mechanism. Maturation of whole-brain neural networks can be quantified during development using diffusion magnetic resonance imaging (dMRI) in combination with graph theory metrics. DMRI of 35 subjects with CHD and 62 subjects with HIE were compared to understand differences in the effects of HIE and CHD on the development of network topological parameters and functional outcomes. CHD newborns had worse 12–18 month language (P<0.01) and 30 month cognitive (P<0.01), language (P = 0.05), motor outcomes (P = 0.01). Global efficiency, a metric of brain integration, was lower in CHD (P = 0.03) than in HIE, but transitivity, modularity and small-worldness were similar. After controlling for clinical factors known to affect neurodevelopmental outcomes, we observed that global efficiency was highly associated with 30 month motor outcomes (P = 0.02) in both groups. To explore neural correlates of adverse language outcomes in CHD, we used hypothesis-based and data-driven approaches to identify pathways with altered structural connectivity. We found that connectivity strength in the superior longitudinal fasciculus (SLF) tract 2 was inversely associated with expressive language. After false discovery rate correction, a whole connectome edge analysis identified 18 pathways that were hypoconnected in the CHD cohort as compared to HIE. In sum, our study shows that neonatal structural connectivity predicts early motor development after HIE or in subjects with CHD, and regional SLF connectivity is associated with language outcomes. Further research is needed to determine if and how brain networks change over time and whether those changes represent recovery or ongoing dysfunction. This knowledge will directly inform strategies to optimize neurologic functional outcomes after neonatal brain injury.
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18
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Zhu M, Zhao D, Wang Y, Zhou Q, Wang S, Mo X, Yang M, Sun Y. Multi-Slice Radiomic Analysis of Apparent Diffusion Coefficient Metrics Improves Evaluation of Brain Alterations in Neonates With Congenital Heart Diseases. Front Neurol 2020; 11:586518. [PMID: 33362694 PMCID: PMC7759540 DOI: 10.3389/fneur.2020.586518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
Apparent diffusion coefficients (ADC) can provide phenotypic information of brain lesions, which can aid the diagnosis of brain alterations in neonates with congenital heart diseases (CHDs). However, the corresponding clinical significance of quantitative descriptors of brain tissue remains to be elucidated. By using ADC metrics and texture features, this study aimed to investigate the diagnostic value of single-slice and multi-slice measurements for assessing brain alterations in neonates with CHDs. ADC images were acquired from 60 neonates with echocardiographically confirmed non-cyanotic CHDs and 22 healthy controls (HCs) treated at Children's Hospital of Nanjing Medical University from 2012 to 2016. ADC metrics and texture features for both single and multiple slices of the whole brain were extracted and analyzed to the gestational age. The diagnostic performance of ADC metrics for CHDs was evaluated by using analysis of covariance and receiver operating characteristic. For both the CHD and HC groups, ADC metrics were inversely correlated with the gestational age in single and multi-slice measurements (P < 0.05). Histogram metrics were significant for identifying CHDs (P < 0.05), while textural features were insignificant. Multi-slice ADC (P < 0.01) exhibited greater diagnostic performance for CHDs than single-slice ADC (P < 0.05). These findings indicate that radiomic analysis based on ADC metrics can objectively provide more quantitative information regarding brain development in neonates with CHDs. ADC metrics for the whole brain may be more clinically significant in identifying atypical brain development in these patients. Of note, these results suggest that multi-slice ADC can achieve better diagnostic performance for CHD than single-slice.
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Affiliation(s)
- Meijiao Zhu
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Dadi Zhao
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ying Wang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qinghua Zhou
- Department of Informatics, University of Leicester, Leicester, United Kingdom
| | - Shujie Wang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xuming Mo
- Department of Cardio-Thoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Sun
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
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19
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Zhu S, Sai X, Lin J, Deng G, Zhao M, Nasser MI, Zhu P. Mechanisms of perioperative brain damage in children with congenital heart disease. Biomed Pharmacother 2020; 132:110957. [PMID: 33254442 DOI: 10.1016/j.biopha.2020.110957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022] Open
Abstract
Congenital heart disease, particularly cyanotic congenital heart disease (CCHD), may lead to a neurodevelopmental delay through central nervous system injury, more unstable central nervous system development, and increased vulnerability of the nervous system. Neurodevelopmental disease is the most serious disorder of childhood, affecting the quality of life of children and their families. Therefore, the monitoring and optimization of nerve damage treatments are important. The factors contributing to neurodevelopmental disease are primarily related to preoperative, intraoperative, postoperative, genetic, and environmental causes, with intraoperative causes being the most influential. Nevertheless, few studies have examined these factors, particularly the influencing factors during early postoperative care. Children with congenital heart disease may experience brain damage during early heart intensive care due to unstable haemodynamics and total body oxygen transfer, particularly early postoperative inflammatory reactions in the brain, blood glucose levels, and other factors that potentially influence long-term neural development. This study analyses the forms of structural and functional brain damage in the early postoperative period, along with the recent evolution of research on its contributing factors.
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Affiliation(s)
- Shuoji Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Xiyalatu Sai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianxin Lin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Gang Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Mingyi Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
| | - M I Nasser
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
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20
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Feldmann M, Guo T, Miller SP, Knirsch W, Kottke R, Hagmann C, Latal B, Jakab A. Delayed maturation of the structural brain connectome in neonates with congenital heart disease. Brain Commun 2020; 2:fcaa209. [PMID: 33381759 PMCID: PMC7756099 DOI: 10.1093/braincomms/fcaa209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
There is emerging evidence for delayed brain development in neonates with congenital heart disease. We hypothesize that the perioperative development of the structural brain connectome is a proxy to such delays. Therefore, we set out to quantify the alterations and longitudinal pre- to post-operative changes in the connectome in congenital heart disease neonates relative to healthy term newborns and assess factors contributing to disturbed perioperative network development. In this prospective cohort study, 114 term neonates with congenital heart disease underwent cardiac surgery at the University Children's Hospital Zurich. Forty-six healthy term newborns were included as controls. Pre- and post-operative structural connectomes were derived from mean fractional anisotropy values of fibre pathways traced using diffusion MR tractography. Graph theory parameters calculated across a proportional cost threshold range were compared between groups by multi-threshold permutation correction adjusting for confounders. Network-based statistic was calculated for edgewise network comparison. White-matter injury volume was quantified on 3D T1-weighted images. Random coefficient mixed models with interaction terms of (i) cardiac subtype and (ii) injury volume with post-menstrual age at MRI, respectively, were built to assess modifying effects on network development. Pre- and post-operatively, at the global level, efficiency, indicative of network integration, was lower in heart disease neonates than controls. In contrast, local efficiency and transitivity, indicative of network segregation, were higher compared to controls (all P < 0.025 for one-sided t-tests). Pre-operatively, these group differences were also found across multiple widespread nodes (all P < 0.025, accounting for multiple comparison), whereas post-operatively nodal differences were not evident. At the edge-level, the majority of weaker connections in heart disease neonates compared to controls involved inter-hemispheric connections (66.7% pre-operatively; 54.5% post-operatively). A trend showing a more rapid pre- to post-operative decrease in local efficiency was found in class I cardiac sub-type (biventricular defect without aortic arch obstruction) compared to controls. In congenital heart disease neonates, larger white-matter injury volume was associated with lower strength (P = 0.0026) and global efficiency (P = 0.0097). The maturation of the structural connectome is delayed in congenital heart disease neonates, with a pattern of lower structural integration and higher segregation compared to controls. Trend-level evidence indicated that normalized post-operative cardiac physiology in class I sub-types might improve structural network topology. In contrast, the burden of white-matter injury negatively impacts network strength and integration. Further research is needed to elucidate how aberrant structural network development in congenital heart disease represents neural correlates of later neurodevelopmental impairments.
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Affiliation(s)
- Maria Feldmann
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Ting Guo
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto ON M5G 0A4, Canada
- Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto ON M5G 0A4, Canada
| | - Steven P Miller
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto ON M5G 0A4, Canada
- Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto ON M5G 0A4, Canada
| | - Walter Knirsch
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Andras Jakab
- Centre for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
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21
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Ní Bhroin M, Abo Seada S, Bonthrone AF, Kelly CJ, Christiaens D, Schuh A, Pietsch M, Hutter J, Tournier JD, Cordero-Grande L, Rueckert D, Hajnal JV, Pushparajah K, Simpson J, Edwards AD, Rutherford MA, Counsell SJ, Batalle D. Reduced structural connectivity in cortico-striatal-thalamic network in neonates with congenital heart disease. Neuroimage Clin 2020; 28:102423. [PMID: 32987301 PMCID: PMC7520425 DOI: 10.1016/j.nicl.2020.102423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
Impaired brain development has been observed in newborns with congenital heart disease (CHD). We performed graph theoretical analyses and network-based statistics (NBS) to assess global brain network topology and identify subnetworks of altered connectivity in infants with CHD prior to cardiac surgery. Fifty-eight infants with critical/serious CHD prior to surgery and 116 matched healthy controls as part of the developing Human Connectome Project (dHCP) underwent MRI on a 3T system and high angular resolution diffusion MRI (HARDI) was obtained. Multi-tissue constrained spherical deconvolution, anatomically constrained probabilistic tractography (ACT) and spherical-deconvolution informed filtering of tractograms (SIFT2) was used to construct weighted structural networks. Network topology was assessed and NBS was used to identify structural connectivity differences between CHD and control groups. Structural networks were partitioned into core and peripheral nodes, and edges classed as core, peripheral, or feeder. NBS identified one subnetwork with reduced structural connectivity in CHD infants involving basal ganglia, amygdala, hippocampus, cerebellum, vermis, and temporal and parieto-occipital lobe, primarily affecting core nodes and edges. However, we did not find significantly different global network characteristics in CHD neonates. This locally affected sub-network with reduced connectivity could explain, at least in part, the neurodevelopmental impairments associated with CHD.
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Affiliation(s)
- Megan Ní Bhroin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Ireland
| | - Samy Abo Seada
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Electrical Engineering (ESAT/PSI), KU Leuven, Leuven, Belgium
| | - Andreas Schuh
- Department of Computing, Imperial College London, London, UK
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lucillio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kuberan Pushparajah
- Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - John Simpson
- Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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22
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Abstract
Most children born with even the most critical forms of CHD are now surviving well into adulthood. However, with increased survival has come increased recognition of the diverse neurobehavioural and psychosocial challenges these children experience. Among these challenges are deficits in executive function skills, including inhibitory control, working memory, and cognitive flexibility. Over the past several years, whereas inhibitory control and working memory deficits have garnered particular attention among clinicians and interventionists, relatively less attention has been paid to cognitive flexibility. This is unfortunate given both the high prevalence of cognitive flexibility deficits observed in children and adolescents with critical CHD, and also the far-reaching relevance of cognitive flexibility in helping individuals achieve optimal quality of life across the lifespan. This paper reviews the construct of cognitive flexibility, including its definition, development, measurement, and neuroanatomical basis, provides a summary of how cognitive flexibility is affected by CHD, and offers evidence-based recommendations to systematically support the development of cognitive flexibility within the context of CHD.
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23
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Morton SU, Maleyeff L, Wypij D, Yun HJ, Newburger JW, Bellinger DC, Roberts AE, Rivkin MJ, Seidman JG, Seidman CE, Grant PE, Im K. Abnormal Left-Hemispheric Sulcal Patterns Correlate with Neurodevelopmental Outcomes in Subjects with Single Ventricular Congenital Heart Disease. Cereb Cortex 2020; 30:476-487. [PMID: 31216004 PMCID: PMC7306172 DOI: 10.1093/cercor/bhz101] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/02/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022] Open
Abstract
Neurodevelopmental abnormalities are the most common noncardiac complications in patients with congenital heart disease (CHD). Prenatal brain abnormalities may be due to reduced oxygenation, genetic factors, or less commonly, teratogens. Understanding the contribution of these factors is essential to improve outcomes. Because primary sulcal patterns are prenatally determined and under strong genetic control, we hypothesized that they are influenced by genetic variants in CHD. In this study, we reveal significant alterations in sulcal patterns among subjects with single ventricle CHD (n = 115, 14.7 ± 2.9 years [mean ± standard deviation]) compared with controls (n = 45, 15.5 ± 2.4 years) using a graph-based pattern-analysis technique. Among patients with CHD, the left hemisphere demonstrated decreased sulcal pattern similarity to controls in the left temporal and parietal lobes, as well as the bilateral frontal lobes. Temporal and parietal lobes demonstrated an abnormally asymmetric left-right pattern of sulcal basin area in CHD subjects. Sulcal pattern similarity to control was positively correlated with working memory, processing speed, and executive function. Exome analysis identified damaging de novo variants only in CHD subjects with more atypical sulcal patterns. Together, these findings suggest that sulcal pattern analysis may be useful in characterizing genetically influenced, atypical early brain development and neurodevelopmental risk in subjects with CHD.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Lara Maleyeff
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - David Wypij
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Hyuk Jin Yun
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - David C Bellinger
- Department of Neurology
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Amy E Roberts
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Michael J Rivkin
- Department of Neurology
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Radiology
- Stroke and Cerebrovascular Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - J G Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland 20815, USA
| | - P Ellen Grant
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Radiology
| | - Kiho Im
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
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24
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White BR, Rogers LS, Kirschen MP. Recent advances in our understanding of neurodevelopmental outcomes in congenital heart disease. Curr Opin Pediatr 2019; 31:783-788. [PMID: 31693588 PMCID: PMC6852883 DOI: 10.1097/mop.0000000000000829] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients with congenital heart disease (CHD) suffer from a pattern of neurodevelopmental abnormalities including deficits in language and executive function. In this review, we summarize recent studies that examine these outcomes, their risk factors, possible biomarkers, and attempts to develop therapeutic interventions. RECENT FINDINGS The latest literature has highlighted the role of genetics in determining neurologic prognosis, as we have increased our understanding of potentially modifiable perioperative risk factors. The role of potentially neurotoxic medical therapies has become more salient. One recent focus has been how neurodevelopment affects quality of life and leads to a high prevalence of mental illness. Neuroimaging advances have provided new insights into the pathogenesis of deficits. SUMMARY Although many risk factors in CHD are not modifiable, there is promise for interventions to improve neurodevelopmental outcomes in patients with CHD. Biomarkers are needed to better understand the timing and prognosis of injury and to direct therapy. Research into psychosocial interventions is urgently needed to benefit the many survivors with CHD.
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Affiliation(s)
- Brian R. White
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Lindsay S. Rogers
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Matthew P. Kirschen
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
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25
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Schmithorst VJ, Votava-Smith JK, Tran N, Kim R, Lee V, Ceschin R, Lai H, Johnson JA, De Toledo JS, Blüml S, Paquette L, Panigrahy A. Structural network topology correlates of microstructural brain dysmaturation in term infants with congenital heart disease. Hum Brain Mapp 2018; 39:4593-4610. [PMID: 30076775 DOI: 10.1002/hbm.24308] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022] Open
Abstract
Neonates with complex congenital heart disease (CHD) demonstrate microstructural brain dysmaturation, but the relationship with structural network topology is unknown. We performed diffusion tensor imaging (DTI) in term neonates with CHD preoperatively (N = 61) and postoperatively (N = 50) compared with healthy term controls (N = 91). We used network topology (graph) analyses incorporating different weighted and unweighted approaches and subject-specific white matter segmentation to investigate structural topology differences, as well as a voxel-based analysis (VBA) to confirm the presence of microstructural dysmaturation. We demonstrate cost-dependent network inefficiencies in neonatal CHD in the pre- and postoperative period compared with controls, related to microstructural differences. Controlling for cost, we show the presence of increased small-worldness (hierarchical fiber organization) in CHD infants preoperatively, that persists in the postoperative period compared with controls, suggesting the early presence of brain reorganization. Taken together, topological microstructural dysmaturation in CHD infants is accompanied by hierarchical fiber organization during a protracted critical period of early brain development. Our methodology also provides a pipeline for quantitation of network topology changes in neonates and infants with microstructural brain dysmaturation at risk for perinatal brain injury.
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Affiliation(s)
- Vincent J Schmithorst
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jodie K Votava-Smith
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Nhu Tran
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Richard Kim
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Vince Lee
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rafael Ceschin
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hollie Lai
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer A Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joan Sanchez De Toledo
- Pediatric Cardiac Intensive Care Division, Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stefan Blüml
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Lisa Paquette
- Department of Pediatrics, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
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