Executive Functions in Adults With Congenital Heart Disease
Condition: Congenital Heart Disease
MeSH terms: Heart Diseases; Heart Defects, Congenital
Study type: Observational

Summary: 
      Research in children with congenital heart disease (CHD) requiring cardiopulmonary bypass
      surgery in the neonatal period or during early childhood has shown that the survival rate for
      this population has dramatically increased, also for those with the most severe forms of CHD.
      However, they are at significant risk for neurodevelopmental impairments, persisting into
      adolescence. Our research group showed that adolescents with CHD have smaller brain volumes
      than controls and that volume reduction correlates with poorer neurocognitive functioning. It
      is not known whether similar changes can also be found in adults with CHD (ACHD).

      Aims:

        1. To determine intellectual and executive functions in young adults with congenital heart
           disease after childhood cardiopulmonary bypass surgery and to relate these findings to
           results on cerebral magnetic resonance imaging (MRI).

        2. To evaluate risk factors for adverse outcome and alteration on cerebral MRI.

        3. To examine the effect of poorer intellectual and executive functioning on academic
           achievement, quality of life, and psychosocial functioning.

      Methodology:

      Outcome variables: Intellectual and executive functioning as well as cerebral MRI.

      Participants: Study subjects will be recruited from a large cohort that has been enrolled in
      a study on quality of life in ACHD. The investigators aim to include a maximum of 60 subjects
      per group (ACHD, controls). Variables and risk factors influencing outcome have already been
      assessed through that study. Cerebral MRI will be analysed for structural abnormalities, and
      volumetric, morphometric as well as connectivity analyses will be performed to
      comprehensively characterize cerebral architecture in ACHD and to compare it with that of
      healthy controls.

      Inclusion criteria: Patients with congenital heart disease, cardiopulmonary bypass surgery
      during childhood, age 18 to 30 years Exclusion criteria: Known genetic syndromes or
      chromosomal abnormalities as well as other congenital or acquired diseases leading to mental
      disabilities, exclusion criteria for cerebral MRI.
    

Detailed description: 
      The overall aim of our project is to study intellectual and executive functions in relation
      to cerebral magnetic resonance imaging (MRI) in young adults with severe congenital heart
      disease (CHD). Risk factors for poorer function and altered brain structure will be examined.
      This will extend the knowledge on the spectrum of potential long-term impairments, risk
      factors and the effect on the patient's quality of life. Only a better understanding of the
      spectrum and contributing factors of neurocognitive impairments in adults will allow for an
      early therapy in childhood and will prevent or ameliorate long-term sequelae for patients
      with CHD.

      Specific aims:

        1. To determine the intellectual and executive function of young adults with congenital
           heart disease after cardiopulmonary bypass surgery during infancy or childhood
           Hypothesis: Intellectual outcome is within the normal range but below that of controls
           and assume to find specific difficulties in certain areas of executive functions.

        2. To perform cerebral MRI and perform morphometric analyses Hypothesis: Cerebral volumes
           will be smaller and regional white matter microstructure will be altered, which
           correlate with intellectual and executive function

        3. To determine patient and medical risk factors associated with adverse outcome
           Hypothesis: Disease severity correlates with intellectual outcome.

        4. To determine the associations between intellectual and executive function and quality of
           life Hypothesis: Functional outcome correlates with quality of life.

      Subjects:

      The patients and controls have participated in a study on quality of life in adults with CHD
      and will be asked to return for this part of the study. So far, 180 patients and 145 controls
      have been enrolled.

      Inclusion Criteria:

        -  Patients with congenital heart disease

        -  Bypass surgery for congenital heart disease

        -  Male and female subject 18 to 30 years of age

        -  Written informed consent by the participant after information about the project

        -  In command of the German language

        -  No exclusion criteria for cerebral MRI

      Exclusion Criteria:

        -  Known genetic syndromes or chromosomal abnormalities as well as other congenital or
           acquired diseases leading to mental disabilities

        -  Exclusion criteria for cerebral MRI

      Outcome measures:

      Intelligence will be assessed with the Wechsler Adult Intelligence Scale IV edition.

      A large battery using standardized tests will be administered for the executive function
      assessment. This includes the following domains: Working and visual memory, inhibition,
      flexibility, planning, fluency, attention and questionnaires will assess the everyday
      functioning regarding executive functions (behavior rating inventory of executive
      functions-BRIEF).

      Medical and sociodemographic data These data have already been obtained by the ongoing study.

      Cerebral MRI MRI will be performed with a 3.0-T whole-body system (Signa Twinspeed Excite; GE
      Healthcare, Milwaukee, Wisconsin). Three-dimensional anatomic images of the entire brain will
      be obtained using a T1-weighted gradient echo pulse sequence (repetition time, 25 msec; echo
      time, 5 msec) and a T2-weighted spin echo pulse sequence (repetition time,6660 msec; echo
      time, 97.6 msec).

      Time schedule Recruitment and testing phase 6-9 months, data entry, data control and
      preliminary data analysis 3 months.

      Start of the project: January 1st, 2017, duration: 1 year.

      Statistical Plan The sample size estimated is 51 participants per group given a two-sided
      alpha of 0.05 and a power of 90% resulting in a total of 102 participants for the study. In
      order to control for drop-outs, each group will comprise 60 subjects. Data will be analyzed
      using SPSS statistic software version 23 (SPSS inc., Chicago). Parametric or non-parametric
      procedures will be used to compare patients and controls with regard to outcome variables. To
      examine the role of predictors for the outcomes multivariate regression analyses will be
      performed.

      Ethics Ethical approval is available for the assessment of neurocognitive and executive
      functions. An amendment is currently being submitted for the cerebral MRI part.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        adults with congenital heart disease followed at the University Hospital Zürich