Congenital heart diseaseCohort study
Magnetic Resonance Spectroscopy of Brain Metabolism in Fetuses With Congenital Heart Disease
- Prospective observational study
Authors' conclusion
CHD is associated with altered cerebral metabolites in utero, particularly in the third trimester period of pregnancy, which is characterized by exponential brain growth and maturation, and is associated with survival to hospital discharge.
Study context
- Population
- Fetuses with complex congenital heart disease (CHD) and healthy fetuses undergoing fetal MRI with cerebral proton MR spectroscopy
- Participants
- 333 fetuses · 503 spectroscopy images
- Exposure
- Fetuses with complex CHD vs healthy fetuses
- CHDn = 112
- Controlsn = 221reference
- Outcome
- Differences in cerebral biochemical profile (metabolites quantified by LCModel), related to infant outcomes
Main finding
As reported in the abstract
| Group | Mean choline | NAA:choline ratio |
|---|---|---|
| CHD | 2.47 IU ± 0.44 | 1.34 ± 0.40 IU |
| Controls | 2.35 IU ± 0.45 | 1.44 ± 0.48 IU |
- CHD vs Controls: P = 0.02 — choline higher in CHD
- CHD vs Controls: P = 0.001 — NAA:choline ratio lower in CHD
Observational data: associations, not effects.
Further findings
| Outcome | Values | OR | P value |
|---|---|---|---|
| Cerebral lactate, by CHD subtype (subgroup) | Transposition of the great arteries median 1.63 (IQR 0.56–3.27) · Single-ventricle CHD median 1.28 (IQR 0–2.42) · 2-ventricle CHD median 0.79 (IQR 0–1.45) | ||
| Death before discharge, by cerebral lactate · increased odds of death before discharge | 1.75 | P = 0.04 |
Cerebral lactate, by CHD subtype (subgroup)
- Lactate detected in all cohorts; increased in transposition and single-ventricle CHD vs 2-ventricle CHD
Original publication
Magnetic Resonance Spectroscopy of Brain Metabolism in Fetuses With Congenital Heart Disease. J Am Coll Cardiol. Published 17 October 2023. doi:10.1016/j.jacc.2023.08.013
Summarised from the published abstract; every number is checked against it