Tesi etd-11022020-075403
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Tipo di tesi
Corso Ordinario Ciclo Unico 6 Anni
Autore
DI SALLE, GIANFRANCO
URN
etd-11022020-075403
Titolo
Cardiac Physiology Predicts brain metabolic maturation in infants with congenital heart disease: a longitudinal MR spectroscopy study
Struttura
Cl. Sc. Sperimentali - Medicina
Corso di studi
SCIENZE MEDICHE - SCIENZE MEDICHE
Commissione
Tutor Prof. RECCHIA, FABIO ANASTASIO
Presidente Prof. EMDIN, MICHELE
Membro Prof. MEOLA, MARIO
Membro Dott.ssa PETRUCCI, ILARIA
Membro Dott. GIANNONI, ALBERTO
Membro Prof. PASSINO, CLAUDIO
Membro Prof. COCEANI, FLAVIO
Membro Prof. LIONETTI, VINCENZO
Membro Dott.ssa ANGELONI, DEBORA
Membro Dott.ssa CASIERI, VALENTINA
Relatore Prof. MILLER, STEVEN P.
Presidente Prof. EMDIN, MICHELE
Membro Prof. MEOLA, MARIO
Membro Dott.ssa PETRUCCI, ILARIA
Membro Dott. GIANNONI, ALBERTO
Membro Prof. PASSINO, CLAUDIO
Membro Prof. COCEANI, FLAVIO
Membro Prof. LIONETTI, VINCENZO
Membro Dott.ssa ANGELONI, DEBORA
Membro Dott.ssa CASIERI, VALENTINA
Relatore Prof. MILLER, STEVEN P.
Parole chiave
- Nessuna parola chiave trovata
Data inizio appello
14/12/2020;
Disponibilità
completa
Riassunto analitico
BACKGROUND: Congenital Heart Disease (CHD), including Transposition of the Great Arteries (TGA) and Single Ventricle Physiology (SVP), is associated with brain injury and impaired development. We hypothesize that brain metabolic development in infants with TGA normalizes in the first few months after corrective cardiac surgery, relative to those with SVP whose cerebral oxygen delivery is persistently impaired.
DESIGN/METHODS: Thirty-three term infants with CHD (19 TGA, 14 SVP) were prospectively studied with MR spectroscopy (MRS) at 3 time points: preop (N=21), postop (N=26), and at 4 months (N=31). Single-voxel MRS was acquired on the left basal ganglia. Spectra were quantified to generate absolute concentrations of N-acetylaspartate (NAA), a marker of neuronal integrity and metabolism, and lactate, a measure of cerebral oxidative metabolism: 19 preop, 25 postop, and 25 4-month scans.
RESULTS: NAA robustly increases over time (0.26 mM/week; P<0.001), while lactate (-0.002; P=0.7) shows no significant change. NAA increase is attenuated in SVP cohort, relative to TGA, accounting for GA (-0.06mM/week, interaction term- diagnosis*PMA at scan P=0.1). Neonatal brain injury was prevalent: moderate white matter injury (WMI) (preop 3/19, new postop 4/25) and stroke (preop: 3/19, new postop 3/25). In longitudinal analyses, WMI predicted a slower NAA increase over time (-0.28 mM/week PMA, P<0.0001) accounting for CHD diagnosis. Importantly, this finding was apparent on the neonatal scans; by age 4 months, WMI did not predict differences in NAA levels (-0.007 mM; P=0.9). Stroke was not associated with NAA.
CONCLUSIONS: Early brain metabolic development in CHD infants is related to cardiac physiology and WMI. Neuronal metabolism impairments over the first months of life are more strongly related to impaired cardiovascular function than to neonatal brain injury.
DESIGN/METHODS: Thirty-three term infants with CHD (19 TGA, 14 SVP) were prospectively studied with MR spectroscopy (MRS) at 3 time points: preop (N=21), postop (N=26), and at 4 months (N=31). Single-voxel MRS was acquired on the left basal ganglia. Spectra were quantified to generate absolute concentrations of N-acetylaspartate (NAA), a marker of neuronal integrity and metabolism, and lactate, a measure of cerebral oxidative metabolism: 19 preop, 25 postop, and 25 4-month scans.
RESULTS: NAA robustly increases over time (0.26 mM/week; P<0.001), while lactate (-0.002; P=0.7) shows no significant change. NAA increase is attenuated in SVP cohort, relative to TGA, accounting for GA (-0.06mM/week, interaction term- diagnosis*PMA at scan P=0.1). Neonatal brain injury was prevalent: moderate white matter injury (WMI) (preop 3/19, new postop 4/25) and stroke (preop: 3/19, new postop 3/25). In longitudinal analyses, WMI predicted a slower NAA increase over time (-0.28 mM/week PMA, P<0.0001) accounting for CHD diagnosis. Importantly, this finding was apparent on the neonatal scans; by age 4 months, WMI did not predict differences in NAA levels (-0.007 mM; P=0.9). Stroke was not associated with NAA.
CONCLUSIONS: Early brain metabolic development in CHD infants is related to cardiac physiology and WMI. Neuronal metabolism impairments over the first months of life are more strongly related to impaired cardiovascular function than to neonatal brain injury.
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