Cerebral Artery Integrity Linked to Brain Injury and Cognition in Congenital Heart Disease

项目总结/摘要 患有先天性心脏病（CHD）的青少年表现出脑损伤的区域（海马，额叶 皮质、颞叶和顶叶），这些区域控制认知。在这些网站上的abbreviation与 认知缺陷然而，CHD中这些区域脑损伤的根本原因尚不清楚。的改变 脑动脉完整性（通过动脉通过时间[ATT]测量），这与其他神经损伤有关。 是冠心病脑损伤的潜在原因。然而，目前还没有发表的报告，脑动脉 冠心病的脑动脉完整性，脑损伤和认知之间的任何关联， 这个条件。我们将采用比较研究设计，80例受试者（40例CHD / 40例健康对照）， CHD的入选标准将是年龄在14-18岁之间的受试者，接受过手术修复或 缓解组和对照组将与CHD受试者年龄和性别匹配。使用非侵入性脑磁 我们的初步研究首次报道了ATT值的异常 (via弥散加权伪连续动脉自旋标记[pCASL]程序），这些 变化与脑损伤有关（如通过基于平均扩散率的扩散张量成像[MD]所检查的， 组织完整性的MRI测量）在CHD患者的海马、额叶皮质、颞叶和顶叶区域 与对照组相比。然而，虽然有希望，但这项初步研究的样本量相当大， 小，不允许我们控制重要的协变量，如年龄和性别。所以具体 该建议的目的是：1）比较CHD之间的ATT值（根据弥散加权pCASL计算）， 和年龄和性别匹配的对照受试者; 2）比较区域MD值，来自扩散张量 成像数据和认知评分（通过蒙特利尔认知评估[莫卡]和 来自记忆和学习广泛评估[WRAML 2]的一般记忆指数（GMI）评分） CHD与年龄和性别匹配的对照受试者之间的关系; 3）检查改变的CHD与年龄和性别匹配的对照受试者之间的关系。 ATT（指示脑动脉完整性）、局部MD值（损伤评估）和认知评分， 冠心病患者。 总之，CHD患者在控制认知的区域显示出显著的脑损伤。这些赤字是 与学校成绩差、发病率和死亡率增加以及生活质量差有关。一 这种脑损伤的潜在原因可能是脑动脉完整性受损;然而， 冠心病患者的脑组织完整性及其与脑损伤和认知功能的关系尚未见报道。信息从 本研究有可能揭示冠心病脑损伤的过程。因此，它具有重要的 通过修复脑动脉完整性确定冠心病有效治疗方法的意义， 其他条件（如中风和创伤性脑损伤），这可能会显着改善认知能力 功能，降低死亡率和发病率，并提高生活质量，在这个高风险的患者群体。

PROJECT SUMMARY/ ABSTRACT Adolescents with congenital heart disease (CHD) show brain injury in regions (hippocampus, frontal cortex, temporal, and parietal), which control cognition. Abnormalities in these sites are associated with cognitive deficits. However, the underlying cause of brain injury in these areas in CHD is unclear. Alteration in cerebral artery integrity (measured by arterial transit time [ATT]), which is associated with neural injury in other diseases, is a potential cause of brain injury in CHD. However, there are no published reports of cerebral artery integrity in CHD or regarding any associations between cerebral artery integrity, brain injury, and cognition in this condition. We will use a comparative study design, 80 subjects (40 CHD / 40 Healthy controls), with inclusion criteria for CHD will be subjects between 14-18 years of age, have undergone surgical repair or palliation, and controls will be age- and gender-matched to CHD subjects. Using non-invasive brain magnetic resonance imaging (MRI) procedures, our preliminary study is the first to report abnormalities in ATT values (via diffusion-weighted pseudo-continuous arterial spin labeling [pCASL] procedures) in CHD and that these changes are associated with brain injury (as examined by diffusion tensor imaging based mean diffusivity [MD], an MRI measure of tissue integrity) in the hippocampus, frontal cortex, temporal, and parietal regions in CHD subjects compared to controls. However, while promising, the sample size in this preliminary study was quite small and did not allow us to control for important covariates, such as age and gender. Therefore, the specific aims of this proposal are to: 1) compare ATT values (calculated from diffusion-weighted pCASL) between CHD and age- and gender-matched control subjects; 2) compare regional MD values, derived from diffusion tensor imaging data and cognitive scores (measured by the total Montreal Assessment of Cognition [MoCA] and general memory index (GMI) score from the Wide Range Assessment of Memory and Learning [WRAML2]) between CHD and age- and gender-matched control subjects; 3) examine the relationships between altered ATT (indicating cerebral artery integrity), regional MD values (assessment of injury), and cognitive scores in CHD patients. In summary, CHD patients show significant brain injury in areas that control cognition. These deficits are associated with poor school performance, increased morbidity and mortality, and poorer quality of life. A potential cause of this brain injury may be compromised cerebral artery integrity; however, status of the artery integrity and its association with brain injury and cognition has not been reported in CHD. Information from this study has the potential to disclose a process contributing to brain injury in CHD. Thus, it has important implications on identification of effective treatments for CHD by repairing cerebral artery integrity as used in other conditions (such as stroke and traumatic brain injury), which could dramatically improve cognitive function, reduce mortality and morbidity, and increase quality of life in this high risk patient population.