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Published on: March 10, 2020
Cortical structure alterations in toddlers with different severities of congenital heart disease: a cross-sectional
Fan Lu1, Yuting Liu1, Sizhe Lu2
1Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, 210019, Jiangsu Province, China.
Insights
Toddlers with congenital heart disease (CHD) show altered cortical structure, even in mild cases. These brain changes are linked to neurodevelopmental outcomes and hemoglobin levels, suggesting early intervention targets.
Area of Science:
- Neuroscience
- Developmental Biology
- Pediatric Cardiology
Background:
- Neurodevelopmental risks in complex congenital heart disease (CHD) are known, but less is understood about mild CHD's neuroanatomical effects.
- This study investigates cortical structure in toddlers with varying CHD severities and its relation to neurodevelopment.
Purpose of the Study:
- To characterize cortical structure in toddlers with congenital heart disease (CHD) across different severities.
- To explore associations between cortical structure, preoperative laboratory values, and neurodevelopmental outcomes in these children.
Main Methods:
- Magnetic resonance imaging (MRI) was used to assess cortical structure (grey matter volume and thickness) in 109 toddlers with CHD and 56 healthy controls (HCs).
- Gesell Developmental Schedules were administered to CHD toddlers, who were stratified by CHD severity.
- Generalized linear models analyzed differences in cortical structure and relationships with laboratory values and neurodevelopment.
Main Results:
- Toddlers with mild and moderate-to-severe CHD showed reduced total brain volume and grey matter volume (GMV) compared to HCs.
- Significant reductions in cortical GMV and thickness were found in specific brain regions across all CHD severity groups.
- Altered cortical structures correlated with neurodevelopmental domains (adaptive, gross motor, fine motor skills) and hemoglobin levels.
Conclusions:
- Congenital heart disease (CHD) is associated with variations in grey matter volume and cortical thickness, irrespective of disease severity.
- Mild CHD cases exhibited cortical alterations comparable to moderate-to-severe cases, highlighting the need for early neurodevelopmental consideration.
- Cortical structure may serve as a neuroimaging marker linking preoperative factors to neurodevelopmental outcomes, indicating potential intervention targets.
Abstract:
The aim of this study was to characterise the cortical structure in toddlers with congenital heart disease (CHD) of varying severities and to investigate its associations with preoperative laboratory values and neurodevelopmental outcomes. A cohort of 109 toddlers with CHD and 56 healthy controls (HCs) underwent magnetic resonance imaging between August 2021 and December 2023. All toddlers with CHD were assessed using the Gesell Developmental Schedules and stratified into mild, moderate, and severe groups. Generalised linear models were used to compare cortical structural (grey matter volume (GMV) and thickness) differences across CHD severity groups and HCs and to examine their relationships with preoperative laboratory values and neurodevelopmental outcomes. Compared with HCs, toddlers with mild and moderate-to-severe CHD exhibited reduced total brain volume and total GMV. Significant reductions in cortical GMV and thickness were observed in specific brain regions (p < 0.001, family-wise error corrected). Altered cortical structures demonstrated overlapping spatial distributions between the mild and moderate-to-severe CHD groups. In the mild and moderate-to-severe CHD groups, regional alterations were correlated with scores across multiple neurodevelopmental domains (adaptive, gross motor, and fine motor skills), and haemoglobin levels were associated with cortical thickness in the right superior frontal area (β = 0.422; pfwe = 0.021; 95% CI, 0.002-0.007).
Conclusion:
Toddlers with CHD exhibit GMV and cortical thickness variations across all CHD severity levels in this study. Notably, toddlers with mild CHD may demonstrate alterations comparable to those in the moderate-to-severe group at this developmental stage. These cortical alterations may merit early consideration during neurodevelopmental trajectories, irrespective of CHD severity.
What Is Known:
• While neurodevelopmental risks and behavioural abnormalities in children with complex CHD are well-established, less is known about the neuroanatomical alterations and neurodevelopmental outcomes of those with mild CHD.
What Is New:
• Toddlers with CHD exhibit similar cortical structural alterations across all severity groups in this study. • Cortical structure was associated with haemoglobin levels and neurodevelopmental outcomes, suggesting it may lie on a pathway linking preoperative laboratory values to neurodevelopment. This positions it as a potential neuroimaging correlate of NDD and a candidate target for interventions aimed at improving outcomes.
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