Brain volumes in adults with congenital heart disease correlate with executive function abilities

Abstract

Congenital heart disease is the most common birth defect, and patients are at risk for neurodevelopmental impairment and brain abnormalities. Yet, little is known about the link between brain volumes and cognitive function in adults with congenital heart disease. Forty-four patients and 53 controls between 18 and 32 years underwent brain magnetic resonance imaging and cognitive testing, assessed with an intelligence quotient and executive function global score. Associations between brain volumes and cognitive function were calculated using linear models. Cognitive function in patients was within the normal range (intelligence quotient: 97.74 (10.76)). Total brain volume was significantly smaller in patients compared to controls (1067.26 (113.53) vs 1113.04 (97.88) cm3, P < 0.01), irrespective of cardiac factors (heart defect complexity, cyanosis, cardiopulmonary bypass: all P > 0.4). After adjusting for total brain volume, only corpus callosum volume remained significantly smaller (P = 0.03). Smaller total brain volume was associated with poorer overall executive functioning (P = 0.02) and inhibition (P < 0.01), in both patients and controls. The association between total brain volume and overall executive functioning was moderated by parental socioeconomic status (lower socioeconomic status was associated with a stronger association between brain volume and EF; interaction P = 0.03). In adults with congenital heart disease, despite normal intelligence quotient, brain volume alterations persist into adulthood and are related to executive functioning, in particular inhibitory control. Adults coming from low socioeconomic background and with altered brain volumes are especially vulnerable and should thus be followed-up during adulthood to ensure optimal social and educational support.

Perioperative Course and Socioeconomic Status Predict Long-Term Neurodevelopment Better Than Perioperative Conventional Neuroimaging in Children with Congenital Heart Disease

“…47,48 Interestingly, significant associations have been found between TBV and IQ, executive, and motor outcomes for school-age children, adolescents, and adults. [49][50][51][52] One reason that TBV is possibly associated with outcome in cross-sectional studies but not in longitudinal studies might be that no additional factors accumulating over time contribute to the variance in outcome.…”

Microstructural alterations of the corticospinal tract are associated with poor motor function in patients with severe congenital heart disease

“…These alterations in brain volume are associated with poorer neurodevelopmental outcome in CHD patients: Studies in infants with CHD have shown that altered brain volume at infancy predicts cognitive abilities in later childhood, including intellectual function ( Meuwly et al, 2019 ) and language development ( Rollins et al, 2017 ). Several studies in adolescents and young adults with CHD demonstrated associations between lower local and total brain volume and intellectual function ( Von Rhein et al, 2014 ), working memory ( Fontes et al, 2019 , Latal et al, 2016 ), and executive function ( Naef et al, 2021 , Semmel et al, 2018 ). In addition to macroscopic alterations in brain volume, neuroimaging studies have also revealed alterations in brain microstructure in infants, children and young adults with CHD, which also appear to be linked to delayed or altered cognitive development.…”

A diffusion MRI study of brain white matter microstructure in adolescents and adults with a Fontan circulation: Investigating associations with resting and peak exercise oxygen saturations and cognition

“…Significant reductions in global brain volume and subcortical gray matter (GM) volume were associated with lower SaO 2 in our adolescent and adult Fontan cohort ( Verrall et al, 2021 ), consistent with our earlier findings from adults with other forms of cyanotic CHD ( Cordina et al, 2014 ). Smaller global brain volumes were associated with worse cognitive outcomes in our Fontan cohort ( Verrall et al, 2021 ), and other older CHD cohorts ( Naef et al, 2021 , von Rhein et al, 2014 ). Importantly, associations between hypoxemia and WM microstructure in people with a Fontan circulation and subsequent cognitive impairment have not yet been established.…”