In infants with congenital heart disease autonomic dysfunction is associated with pre-operative brain injury

Abstract

Background: Brain injury is a serious and common complication of critical congenital heart disease (CHD). Impaired autonomic development (assessed by heart rate variability; HRV) is associated with brain injury in other high-risk neonatal populations. Objective: To determine whether impaired early neonatal HRV is associated with pre-operative brain injury in CHD. Methods: In infants with critical CHD, we evaluated HRV during the first 24 hours of cardiac ICU (CICU) admission using time-domain (RMS1, RMS2, and alpha 1) and frequency-domain metrics (LF, nLF, HF, nHF). Pre-operative brain MRI was scored for injury using an established system. Spearman’s correlation coefficient was used to determine the association between HRV and pre-operative brain injury. Results: We enrolled 34 infants with median birth gestational age (GA) of 38.8 weeks (IQR 38.1-39.1). Median postnatal age (PNA) at pre-operative brain MRI was 2 days (IQR 1-3 days). Thirteen infants had MRI evidence of brain injury. RMS 1 and RMS 2 were inversely correlated with pre-operative brain injury. Conclusions: Time-domain metrics of autonomic function measured within the first 24 hours of admission to the CICU are associated with pre-operative brain injury, and may perform better than frequency domain metrics under non-stationary conditions such as critical illness.

Discovery of GJC1 (Cx45) as a New Gene Underlying Congenital Heart Disease and Arrhythmias

“…Based on specific anatomic deformities, CHD has been clinically classified into over 25 distinctive entities, including tetralogy of Fallot (TOF), Ebstein’s anomaly, atrial septal defect (ASD), truncus arteriosus, ventricular septal defect (VSD), coarctation of the aorta, interrupted aortic arch, double outlet right ventricle (DORV), endocardial cushion defect (ECD), atrioventricular septal defect (AVSD), hypoplasia of the left ventricle, aortic stenosis, transposition of the great arteries, anomalous pulmonary venous connection, and patent ductus arteriosus [ 2 ]. Although slight lesions may resolve spontaneously [ 2 ], severe CHD, which accounts for almost one-third of all types of CHD [ 1 ], requires timely medical intervention or surgery, and otherwise may lead to diminished exercise performance and degraded health-associated quality of life [ 3 , 4 , 5 , 6 , 7 ], delayed central nervous development and brain damage [ 8 , 9 , 10 ], ischemic cerebral stroke [ 11 , 12 ], pulmonary arterial hypertension and impaired pulmonary function [ 13 , 14 , 15 , 16 ], chronic kidney disease and acute renal injury [ 17 , 18 , 19 , 20 ], infective endocarditis [ 21 , 22 , 23 , 24 ], aortic dissection and rupture [ 25 ], chronic heart failure [ 26 , 27 ], cardiac dysrhythmias [ 28 , 29 , 30 ], and cardiac premature demise [ 31 , 32 , 33 , 34 ]. Over the past several decades, significant improvement in drug therapy and surgical treatment of CHD has been achieved, which remarkably changes the natural history of severe CHD, allowing over 90% of CHD newborns to survive into adulthood [ 1 ].…”