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

Q: What are the key findings of this study?

Congenital heart disease patients had lower corticospinal tract fractional anisotropy and more frequent motor impairments (24% vs 9%, p=0.010) than controls, correlating in severe CHD.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Congenital heart disease (CHD) (n=186). Intervention: Congenital heart disease (stratified by simple, moderate, and severe complexity) and corticospinal tract (CST) microstructural alterations (fractional anisotropy) vs. Age- and sex-matched healthy controls. Primary outcome: Clinically relevant motor impairments (fine and/or pure motor z-score < -2 on the Zurich Neuromotor Assessment) (Cohen's d 0.52 (for pure motor performance), 95% CI 0.29-1.04, p=0.010).

Q: What does this research mean for the field?

Patients with congenital heart disease exhibit lower corticospinal tract fractional anisotropy and more frequent motor impairments than healthy controls, with corticospinal tract microstructure specifically correlating with pure motor deficits in patients with severe disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Melanie Ehrler; Michael von Rhein; Ladina Schlosser; Peter Brugger; Matthias Greutmann; Oliver Kretschmar; Beatrice Latal; Ruth Tuura O’Gorman

doi:10.1016/j.nicl.2021.102885

January 1, 2021NeuroImage ClinicalOpen Access

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

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Key result

CHD linked to ~15-point higher rate of motor impairments vs healthy controls.

Cohen's d +0.52 (for pure motor performance)
95% CI 0.29-1.04
P=0.010
n=186

Figures

Why the study?

CHD patients are at risk for neurodevelopmental impairments, but little is known about the neuroanatomical correlates of persistent motor deficits in this population.

Are microstructural alterations of the corticospinal tract (measured by fractional anisotropy on DTI) associated with impaired fine and pure motor performance in adolescents and adults with congenital heart disease compared to healthy controls?

Key Points

To examine whether microstructural alterations of the corticospinal tract correlate with persistent fine and pure motor deficits in adolescents and adults with congenital heart disease compared to healthy controls.
Assessed 89 congenital heart disease patients (47 adolescents, 42 adults; mean age 19.9 years) and 97 age-matched healthy controls (44 adolescents, 53 adults; mean age 20.6 years).
Extracted fractional anisotropy of the left and right corticospinal tract using diffusion tensor imaging and evaluated motor performance using the Zurich Neuromotor Assessment.
Clinically relevant motor impairments (>2 SD below normative mean) occurred in 24% of congenital heart disease patients compared to 9% of controls (p=0.010), with patients showing lower fine motor (mean z-score -0.47 vs 0.06, p=0.002) and pure motor scores (-0.53 vs 0.13, p<0.001).
Corticospinal tract fractional anisotropy was significantly lower in patients than controls across heart disease complexity (left: p<0.001; right: p=0.003).
A significant interaction emerged between heart disease complexity and fractional anisotropy (left: p=0.025; right: p=0.025), showing that fractional anisotropy significantly correlated with pure motor function in severe congenital heart disease (left: β=0.494, p=0.011; right: β=0.556, p=0.021), but not in mild disease or controls.

Study Design

Type

Cross-Sectional (n=186)

Blinding

Examiners were aware of the participant's medical condition but not of the imaging results

Multicenter

No

Structured PICO

Are microstructural alterations of the corticospinal tract (measured by fractional anisotropy on DTI) associated with impaired fine and pure motor performance in adolescents and adults with congenital heart disease compared to healthy controls?

P

Population

186 participants (89 adolescent and adult congenital heart disease patients with mean age 19.9 years and 97 age-matched healthy controls with mean age 20.6 years) without genetic or neurological disorders evaluated cross-sectionally at University Hospital Zurich.

E

Exposure

Congenital heart disease (simple, moderate, and severe complexity) evaluated via 3.0 Tesla brain diffusion tensor imaging (DTI) to extract fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) of the left and right corticospinal tract (CST).

C

Comparator

Age- and sex-matched healthy controls undergoing the same brain DTI and neuromotor test protocols.

O

Outcome

Fine motor (pegboard timed performance) and pure motor (timed repetitive, sequential, and alternating finger, hand, and foot movements) performance z-scores assessed via the Zurich Neuromotor Assessment, and their association with mean fractional anisotropy (FA) of the left and right corticospinal tract (CST).surrogate

Main Result

Standardized Mean Difference: 0.52 (95% CI 0.29–1.04)

Absolute Event Rate: 24% vs 9%

p-value: p=0.010

Adolescents and adults with congenital heart disease exhibit persistent motor deficits and altered corticospinal tract white matter microstructure, with lower fractional anisotropy directly correlating with poorer pure motor function in patients with severe CHD.

Limitations

Data were pooled from two independent study populations with methodological discrepancies regarding assessment period, age range, and extent of neurodevelopmental assessment.
White matter injury was only quantified in one study while rated more unspecifically in the other, and different MRI gradient schemes/scanners were used between samples.
The patient sample included a variety of heart defects with different complexities, preventing conclusions for specific individual heart defects.
Model fit for predicting fine motor performance from CST microstructure was not statistically significant.
Data were pooled from two independent study cohorts with methodological differences in assessment period, age range, MRI scanner/gradient directions, and extent of neurodevelopmental evaluation.
White matter injury was only quantified in one sample and rated unspecifically in the other, limiting risk factor analysis for white matter injury.
Heterogeneity of cardiac diagnoses within complexity groups precludes conclusions for specific individual congenital heart defects.
Models predicting fine motor performance from CST microstructural parameters were not statistically significant.

Implication

Motor deficits in CHD warrant clinical attention; leaves open whether DTI predicts outcomes or guides intervention.

Abstract

Congenital heart disease (CHD) patients are at risk for neurodevelopmental impairments, including altered motor function. However, little is known about the neuroanatomical correlates of persistent motor deficits in CHD. Thus, we examined the link between corticospinal tract (CST) microstructure and motor function in adolescent and adult CHD patients compared to healthy controls. This study investigated 89 CHD patients (N(adolescents)=47, N(adults)=42, mean age=19.9 years) and 97 age-matched healthy controls (N(adolescents)=44, N(adults)=53, mean age=20.6 years). Diffusion tensor imaging was conducted and fractional anisotropy (FA) of the left and right CST was extracted for each participant. Fine (pegboard) and pure motor (repeated finger, hand and foot movements) performance was evaluated with a standardized test battery. FA and motor performance were correlated and the effect of CHD complexity was tested using multivariate linear regression. Clinically relevant motor impairments (>2SD below normative mean) were evident in 24% of patients and 9% of controls. On average, motor performance was lower in CHD patients compared to controls, particularly in those with more complex CHD (fine motor: p=0.023; pure motor: p<0.001). FA CST was lower in patients compared to controls, particularly in those with more complex CHD (left: p<0.001, right: p=0.003). There was a significant interaction between CHD complexity and FA CST (left: p=0.025, right: p=0.025), indicating that FA correlates significantly with pure motor in patients with severe CHD, while there is only a weak association in moderate CHD and no association in patients with simple CHD and controls. Microstructure of the CST is altered in CHD patients, and is associated with pure motor impairments in patients with severe CHD. This indicates that persistent motor impairments may arise from atypical development of the primary motor pathway in the presence of a complex CHD. Early interventions promoting brain maturation in infancy may prevent persisting impairments across the lifetime.

Discussion

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Cite This Study

Ehrler et al. (2021) conducted a cross-sectional in Congenital heart disease (CHD) (n=186). Congenital heart disease (stratified by simple, moderate, and severe complexity) and corticospinal tract (CST) microstructural alterations (fractional anisotropy) vs. Age- and sex-matched healthy controls was evaluated on Clinically relevant motor impairments (fine and/or pure motor z-score < -2 on the Zurich Neuromotor Assessment) (Cohen's d 0.52 (for pure motor performance), 95% CI 0.29-1.04, p=0.010). Congenital heart disease patients had lower corticospinal tract fractional anisotropy and more frequent motor impairments (24% vs 9%, p=0.010) than controls, correlating in severe CHD.

synapsesocial.com/papers/6a7af995a51ded8e7b32fa75 https://doi.org/10.1016/j.nicl.2021.102885

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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