Sex Differences in Psychosocial and Neurocognitive Outcomes in Adults with Moderate to Complex Congenital Heart Disease

项目摘要 先天性心脏病(CHD)是世界上最大的出生缺陷，有240万人(140万人 成年人)在美国。这些数字预计将在未来十年翻一番，超过90%的 冠心病患者步入成年期。尽管医学和外科技术取得了进步，但50%的成年冠心病患者 神经认知缺陷、抑郁和以心脏为中心的焦虑，可能会影响他们的日常生活。然而，在那里 目前还没有研究表明患有精神分裂症的成年人在心理社会和神经认知结果方面的性别差异 中度至复杂的冠心病。只有几项研究考察了神经认知功能或心理社会功能 成年冠心病患者的预后。这些研究表明，注意力等神经认知领域存在缺陷， 执行功能、处理速度、工作记忆和智能。这些缺陷使病人处于 低教育程度、失业、残疾、自理能力差、死亡率增加和 发病率低，生活质量较低，并可能失去医疗随访。不幸的是，这些样本中的小样本 很少有研究限制基于性别/性别差异的进一步分析。为了解决这一关键差距，我们将 招募180名年龄在18岁至40岁之间、被诊断为中度至复杂冠心病的冠心病患者 来自阿曼森/加州大学洛杉矶分校成人冠心病中心。将从以下地点招募40名健康对照的额外样本 洛杉矶社区作为对比。这项横断面的比较研究将包括 评估神经认知、焦虑/抑郁、健康的社会决定因素、精神和 身体功能、社会支持和生活质量。临床数据包括心室射血分数(EF)、 女性的心脏手术次数、冠心病严重程度和更年期状况。具体目标1)检查性别 /心理社会、身体功能、健康的社会决定因素(SDoH)方面的性别差异 与年龄、性别和种族匹配的中度至复杂冠心病成年人的神经认知评分比较 控制。我们假设，与女性冠心病患者相比，男性的神经认知得分更低 和匹配的对照组，而女性冠心病患者的心理社会得分低于男性 CHD和配对对照。具体目标2)确定神经认知得分与性别的关系， 中度至复杂冠心病成人的临床因素、SDoH、心理社会和身体功能。我们 假设手术次数越多，EF越低，身体功能越差，焦虑和焦虑水平越高 抑郁症状、较少的社会支持、SDoH阴性和男性性行为将与病情恶化有关 中度至复杂型冠心病患者的神经认知评分。这项研究将有助于获得新的知识 关于性别/性别差异与神经认知和老年心理社会结果的关系 成年冠心病患者。临床影响是巨大的，因为结果将支持有针对性的开发 干预措施，以改善这一高危、不断增长的人群的神经认知和心理社会结果。

PROJECT ABSTRACT Congenital Heart Disease (CHD) is the number one birth defect worldwide, with 2.4 million people (1.4 million adults) in the United States. Those figures are expected to double in the next decade with more than 90% of CHD patients reaching adulthood. Despite medical and surgical advancements, 50% of adults with CHD have neurocognitive deficits, depression and heart-focused anxiety that can affect their daily life. However, there are no studies that examine sex differences in psychosocial and neurocognitive outcomes in adults with moderate to complex CHD. Only a few studies have examined either neurocognitive function or psychosocial outcomes in adults with CHD. Those studies have shown deficits in neurocognitive domains such as attention, executive function, processing speed, working memory and intelligence. These deficits place the patient at higher risk for lower educational attainment, unemployment, disability, poor self-care, increased mortality and morbidity, lower quality of life and potential loss to medical follow-up. Unfortunately, small sample sizes in these few studies limited further analysis based on sex / gender differences. To address this critical gap, we will recruit 180 CHD participants between 18 to 40 years of age with a diagnosis of moderate-to-complex CHD from the Ahmanson/UCLA Adult CHD Center. An additional sample of 40 healthy controls will be recruited from the Los Angeles community for comparison. This cross-sectional, comparative study will include measurements to assess neurocognition, anxiety/depression, social determinants of health, mental and physical functioning, social support, and quality of life. Clinical data include ventricular ejection fraction (EF), number of cardiac surgeries, CHD severity and menopause status in females. Specific Aim 1) Examine sex /gender differences in psychosocial, physical functioning, social determinants of health (SDoH), and neurocognitive scores in adults with moderate to complex CHD compared to age-, sex-, and ethnicity-matched controls. We hypothesize that males will have worse neurocognitive scores compared to females with CHD and matched controls, while females with CHD will have worse psychosocial scores compared to males with CHD and match controls. Specific Aim 2) Determine the relationship between neurocognitive scores and sex, clinical factors, SDoH, psychosocial, and physical functioning in adults with moderate-to-complex CHD. We hypothesize that greater number of surgeries, lower EF, worse physical function, higher levels of anxiety and depressive symptoms, less social support, negative SDoH, and male sex will be associated with worse neurocognitive scores in adults with moderate to complex CHD. This study will contribute to new knowledge on the association of sex / gender differences related to neurocognition and psychosocial outcomes in aging adults with CHD. The clinical implications are substantial as results will support the development of targeted interventions to improve neurocognitive and psychosocial outcomes in this high-risk, growing population.