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How Neuroimaging Illuminates Links Between CHD and Mental Health
Key Takeaways
A new, systematic review shows structural brain injury is linked to neurodevelopmental difficulties in infants with congenital heart disease (CHD).
The review synthesizes existing evidence on the associations between neuroimaging and neurocognitive, psychiatric and behavioral outcomes among individuals with complex CHD.
The researchers investigated the value of using structural and functional magnetic resonance imaging and other techniques to predict neurocognitive and mental health outcomes.
With advances in cardiovascular medicine, infants born with congenital heart disease (CHD) are surviving at higher rates. This has led researchers to focus their attention on how these conditions affect individuals throughout childhood and into adulthood, especially when it comes to their mental health.
Nadine Kasparian, PhD
Researchers at Cincinnati Children’s, led by Nadine Kasparian, PhD, as well as Sydney Children’s Hospitals Network, Boston Children’s Hospital, UCLA and Children’s Hospital Los Angeles, have published a “State-of-the-Art Review” in the Journal of the American College of Cardiology. The research investigates how neuroimaging findings and mental health outcomes may be linked across life for individuals with complex CHD. The article was published online Dec. 5, 2023.
“Medical and surgical advances have dramatically improved survival rates for babies with congenital heart disease and while many demonstrate tremendous resilience, research also shows children born with heart disease have a greater risk of neurodevelopmental and mental health conditions,” Kasparian says. “We are working to understand why with greater precision.”
A “Meticulous and Important” Study
The goal of the review was to optimize clinical care and guide future research. The review systematically synthesizes existing evidence on the associations between neuroimaging and neurocognitive, psychiatric and behavioral outcomes among individuals with complex CHD, including single-ventricle CHD or transposition of the great arteries (TGA).
The team investigated the value of using structural and functional magnetic resonance imaging (MRI) and other techniques to predict neurocognitive and mental health outcomes. They also explored potential differences in outcomes across age and developmental stages, including infancy, early and later childhood, adolescence and adulthood, as well as CHD types—TGA versus single-ventricle CHD.
We are increasingly learning how microstructural and functional brain changes are linked to neurocognitive outcomes, such as attention and learning in childhood and adolescence. With this comes opportunities to improve future outcomes for children with heart disease.
Nadine Kasparian, PhD
Described by JACC Editor-in-Chief Valentin Fuster, MD, PhD, as a “meticulous and important study,” the research team comprehensively searched six electronic databases to identify and synthesize data from 45 papers from 25 unique studies.
“The research shows structural brain injury is linked to neurodevelopmental difficulties in infants with congenital heart disease,” Kasparian says. “We are increasingly learning how microstructural and functional brain changes are linked to neurocognitive outcomes, such as attention and learning in childhood and adolescence. With this comes opportunities to improve future outcomes for children with heart disease.”
Help for Patients and Families Dealing with Heart Disease
Given the differing methodologies and findings across the studies examined, Kasparian and colleagues emphasized that consistent approaches will be key to replicating and confirming initial findings. More fetal studies, functional neuroimaging studies and studies examining mental health outcomes are especially needed.
Early intervention can help mitigate the potential mental health burden of growing up with congenital heart disease. Cincinnati Children’s launched its Heart and Mind Wellbeing Center in February 2023 to help children, teens and adults with heart disease and their families manage times of difficulty or uncertainty, regain a sense of hope and control, and improve their overall health and well-being.
Since the review article was published, Katelyn Phillips—first author and PhD student—has received an award for most outstanding presentation by a third-year PhD student in pediatrics at University of New South Wales Sydney.
