Research progress on cognitive function in adults with congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Ciyan ¹ ,  CHEN Jimei ²

1. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;
2. Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P.R.China;

Corresponding author：

CHEN Jimei, Email: jimei@hotmail.com

Keywords：

Adult; congenital heart disease; cognitive function; brain developmental disorders; review

DOI：

10.7507/1007-4848.202008065

Video：

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Congenital heart disease (CHD) is a series of structural cardiac abnormalities resulting from abnormal fetal heart development. With the prolongation of survival time, their cognitive function problems begin to be concerned. From fetus period to adulthood, people with complex CHD are more likely to have abnormalities in brains. Children with complex CHD have a significantly increased risk of developmental disorders in cognitive functions, such as intelligence, attention and psychosocial disorders. These diseases persist into their adulthood. Adults with CHD have earlier neurocognitive decline, poorer performance in intelligence, executive function, attention and academic achievement, and are more likely to have mood disorders, higher incidence of mental disorders and lower quality of life. This paper reviews the studies on cognitive function of adult patients with CHD from the dimension of the whole life cycle.

Citation： XIE Ciyan, CHEN Jimei. Research progress on cognitive function in adults with congenital heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1513-1520. doi: 10.7507/1007-4848.202008065 Copy

1.	Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019, 139(14): e698-e800.
2.	Afilalo J, Therrien J, Pilote L, et al. Geriatric congenital heart disease: Burden of disease and predictors of mortality. J Am Coll Cardiol, 2011, 58(14): 1509-1515.
3.	Marelli AJ, Ionescu-Ittu R, Mackie AS, et al. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation, 2014, 130(9): 749-756.
4.	Wu MH, Lu CW, Chen HC, et al. Adult congenital heart disease in a nationwide population 2000-2014: Epidemiological trends, arrhythmia, and standardized mortality ratio. J Am Heart Assoc, 2018, 7(4): e007907.
5.	Gurvitz M, Burns KM, Brindis R, et al. Emerging research directions in adult congenital heart disease: A report from an NHLBI/ACHA working group. J Am Coll Cardiol, 2016, 67(16): 1956-1964.
6.	Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet, 2020, 396(10248): 413-446.
7.	Czyż-Szypenbejl K, Mędrzycka-Dąbrowska W, Kwiecień-Jaguś K, et al. The occurrence of postoperative cognitive dysfunction (POCD) - Systematic review. Psychiatr Pol, 2019, 53(1): 145-160.
8.	Greaves D, Psaltis PJ, Ross TJ, et al. Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91, 829 patients. Int J Cardiol, 2019, 289: 43-49.
9.	Tyagi M, Fteropoulli T, Hurt CS, et al. Cognitive dysfunction in adult CHD with different structural complexity. Cardiol Young, 2017, 27(5): 851-859.
10.	Ilardi D, Ono KE, McCartney R, et al. Neurocognitive functioning in adults with congenital heart disease. Congenit Heart Dis, 2017, 12(2): 166-173.
11.	Nattel SN, Adrianzen L, Kessler EC, et al. Congenital heart disease and neurodevelopment: Clinical manifestations, genetics, mechanisms, and implications. Can J Cardiol, 2017, 33(12): 1543-1555.
12.	Bolduc ME, Lambert H, Ganeshamoorthy S, et al. Structural brain abnormalities in adolescents and young adults with congenital heart defect: A systematic review. Dev Med Child Neurol, 2018, 60(12): 1209-1224.
13.	Peyvandi S, Kim H, Lau J, et al. The association between cardiac physiology, acquired brain injury, and postnatal brain growth in critical congenital heart disease. J Thorac Cardiovasc Surg, 2018, 155(1): 291-300.
14.	Peyvandi S, De Santiago V, Chakkarapani E, et al. Association of prenatal diagnosis of critical congenital heart disease with postnatal brain development and the risk of brain injury. JAMA Pediatr, 2016, 170(4): e154450.
15.	Li Y, Yin S, Fang J, et al. Neurodevelopmental delay with critical congenital heart disease is mainly from prenatal injury not infant cardiac surgery: Current evidence based on a meta-analysis of functional magnetic resonance imaging. Ultrasound Obstet Gynecol, 2015, 45(6): 639-648.
16.	Limperopoulos C, Tworetzky W, McElhinney DB, et al. Brain volume and metabolism in fetuses with congenital heart disease: Evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation, 2010, 121(1): 26-33.
17.	Marino BS, Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: Evaluation and management: A scientific statement from the American Heart Association. Circulation, 2012, 126(9): 1143-1172.
18.	Keir M, Ebert P, Kovacs AH, et al. Neurocognition in adult congenital heart disease: How to monitor and prevent progressive decline. Can J Cardiol, 2019, 35(12): 1675-1685.
19.	Marelli A, Miller SP, Marino BS, et al. Brain in congenital heart disease across the lifespan: The cumulative burden of injury. Circulation, 2016, 133(20): 1951-1962.
20.	Dimitropoulos A, McQuillen PS, Sethi V, et al. Brain injury and development in newborns with critical congenital heart disease. Neurology, 2013, 81(3): 241-248.
21.	Lynch JM, Ko T, Busch DR, et al. Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease. J Thorac Cardiovasc Surg, 2018, 156(4): 1657-1664.
22.	Andropoulos DB, Hunter JV, Nelson DP, et al. Brain immaturity is associated with brain injury before and after neonatal cardiac surgery with high-flow bypass and cerebral oxygenation monitoring. J Thorac Cardiovasc Surg, 2010, 139(3): 543-556.
23.	Bertholdt S, Latal B, Liamlahi R, et al. Cerebral lesions on magnetic resonance imaging correlate with preoperative neurological status in neonates undergoing cardiopulmonary bypass surgery. Eur J Cardiothorac Surg, 2014, 45(4): 625-632.
24.	Mahle WT, Tavani F, Zimmerman RA, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation, 2002, 106(12 Suppl 1): I109-I114.
25.	Back SA, Miller SP. Brain injury in premature neonates: A primary cerebral dysmaturation disorder? Ann Neurol, 2014, 75(4): 469-486.
26.	Fontes K, Rohlicek CV, Saint-Martin C, et al. Hippocampal alterations and functional correlates in adolescents and young adults with congenital heart disease. Hum Brain Mapp, 2019, 40(12): 3548-3560.
27.	Kessler N, Feldmann M, Schlosser L, et al. Structural brain abnormalities in adults with congenital heart disease: Prevalence and association with estimated intelligence quotient. Int J Cardiol, 2020, 306: 61-66.
28.	Poels MM, Ikram MA, van der Lugt A, et al. Incidence of cerebral microbleeds in the general population: The Rotterdam Scan Study. Stroke, 2011, 42(3): 656-661.
29.	Liu YH, Wang DX, Li LH, et al. The effects of cardiopulmonary bypass on the number of cerebral microemboli and the incidence of cognitive dysfunction after coronary artery bypass graft surgery. Anesth Analg, 2009, 109(4): 1013-1022.
30.	Bagge CN, Henderson VW, Laursen HB, et al. Risk of dementia in adults with congenital heart disease: Population-based cohort study. Circulation, 2018, 137(18): 1912-1920.
31.	Jackson JL, Leslie CE, Hondorp SN. Depressive and anxiety symptoms in adult congenital heart disease: Prevalence, health impact and treatment. Prog Cardiovasc Dis, 2018, 61(3-4): 294-299.
32.	Desai R, Patel K, Dave H, et al. Nationwide frequency, sequential trends, and impact of co-morbid mental health disorders on hospitalizations, outcomes, and healthcare resource utilization in adult congenital heart disease. Am J Cardiol, 2020, 125(8): 1256-1262.
33.	Lei Lei E, Ladha K, Mueller B, et al. Noncardiac determinants of death and intensive care morbidity in adult congenital heart disease surgery. J Thorac Cardiovasc Surg, 2020, 159(6): 2407-2415.
34.	Lanz J, Brophy JM, Therrien J, et al. Stroke in adults with congenital heart disease: Incidence, cumulative risk, and predictors. Circulation, 2015, 132(25): 2385-2394.
35.	Singh S, Desai R, Fong HK, et al. Extra-cardiac comorbidities or complications in adults with congenital heart disease: A nationwide inpatient experience in the United States. Cardiovasc Diagn Ther, 2018, 8(6): 814-819.
36.	Billett J, Cowie MR, Gatzoulis MA, et al. Comorbidity, healthcare utilisation and process of care measures in patients with congenital heart disease in the UK: Cross-sectional, population-based study with case-control analysis. Heart, 2008, 94(9): 1194-1199.
37.	Williamson JD, Pajewski NM, Auchus AP, et al. Effect of intensive vs standard blood pressure control on probable dementia: A randomized clinical trial. JAMA, 2019, 321(6): 553-561.
38.	Lachmann G, Feinkohl I, Borchers F, et al. Diabetes, but not hypertension and obesity, is associated with postoperative cognitive dysfunction. Dement Geriatr Cogn Disord, 2018, 46(3-4): 193-206.
39.	Feinkohl I, Winterer G, Pischon T. Hypertension and risk of post-operative cognitive dysfunction (POCD): A systematic review and meta-analysis. Clin Pract Epidemiol Ment Health, 2017, 13: 27-42.
40.	Jefferson AL, Himali JJ, Beiser AS, et al. Cardiac index is associated with brain aging: The Framingham Heart Study. Circulation, 2010, 122(7): 690-697.
41.	Sabayan B, van Buchem MA, Sigurdsson S, et al. Cardiac hemodynamics are linked with structural and functional features of brain aging: The age, gene/environment susceptibility (AGES)-Reykjavik Study. J Am Heart Assoc, 2015, 4(1): e001294.
42.	Cannon JA, Moffitt P, Perez-Moreno AC, et al. Cognitive impairment and heart failure: Systematic review and meta-analysis. J Card Fail, 2017, 23(6): 464-475.
43.	Bouchardy J, Therrien J, Pilote L, et al. Atrial arrhythmias in adults with congenital heart disease. Circulation, 2009, 120(17): 1679-1686.
44.	Kwok CS, Loke YK, Hale R, et al. Atrial fibrillation and incidence of dementia: A systematic review and meta-analysis. Neurology, 2011, 76(10): 914-922.
45.	Avidan MS, Evers AS. Review of clinical evidence for persistent cognitive decline or incident dementia attributable to surgery or general anesthesia. J Alzheimers Dis, 2011, 24(2): 201-216.
46.	Holmgaard F, Vedel AG, Rasmussen LS, et al. The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: A secondary analysis of a randomised trial. Br J Anaesth, 2019, 123(2): 196-205.
47.	Kumpaitiene B, Svagzdiene M, Drigotiene I, et al. Correlation among decreased regional cerebral oxygen saturation, blood levels of brain injury biomarkers, and cognitive disorder. J Int Med Res, 2018, 46(9): 3621-3629.
48.	Kok WF, Koerts J, Tucha O, et al. Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery. Anaesthesia, 2017, 72(3): 359-369.
49.	Yu Y, Zhang K, Zhang L, et al. Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database Syst Rev, 2018, 1(1): Cd010947.
50.	Vedel AG, Holmgaard F, Rasmussen LS, et al. High-target versus low-target blood pressure management during cardiopulmonary bypass to prevent cerebral injury in cardiac surgery patients: A randomized controlled trial. Circulation, 2018, 137(17): 1770-1780.

1. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019, 139(14): e698-e800.
2. Afilalo J, Therrien J, Pilote L, et al. Geriatric congenital heart disease: Burden of disease and predictors of mortality. J Am Coll Cardiol, 2011, 58(14): 1509-1515.
3. Marelli AJ, Ionescu-Ittu R, Mackie AS, et al. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation, 2014, 130(9): 749-756.
4. Wu MH, Lu CW, Chen HC, et al. Adult congenital heart disease in a nationwide population 2000-2014: Epidemiological trends, arrhythmia, and standardized mortality ratio. J Am Heart Assoc, 2018, 7(4): e007907.
5. Gurvitz M, Burns KM, Brindis R, et al. Emerging research directions in adult congenital heart disease: A report from an NHLBI/ACHA working group. J Am Coll Cardiol, 2016, 67(16): 1956-1964.
6. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet, 2020, 396(10248): 413-446.
7. Czyż-Szypenbejl K, Mędrzycka-Dąbrowska W, Kwiecień-Jaguś K, et al. The occurrence of postoperative cognitive dysfunction (POCD) - Systematic review. Psychiatr Pol, 2019, 53(1): 145-160.
8. Greaves D, Psaltis PJ, Ross TJ, et al. Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91, 829 patients. Int J Cardiol, 2019, 289: 43-49.
9. Tyagi M, Fteropoulli T, Hurt CS, et al. Cognitive dysfunction in adult CHD with different structural complexity. Cardiol Young, 2017, 27(5): 851-859.
10. Ilardi D, Ono KE, McCartney R, et al. Neurocognitive functioning in adults with congenital heart disease. Congenit Heart Dis, 2017, 12(2): 166-173.
11. Nattel SN, Adrianzen L, Kessler EC, et al. Congenital heart disease and neurodevelopment: Clinical manifestations, genetics, mechanisms, and implications. Can J Cardiol, 2017, 33(12): 1543-1555.
12. Bolduc ME, Lambert H, Ganeshamoorthy S, et al. Structural brain abnormalities in adolescents and young adults with congenital heart defect: A systematic review. Dev Med Child Neurol, 2018, 60(12): 1209-1224.
13. Peyvandi S, Kim H, Lau J, et al. The association between cardiac physiology, acquired brain injury, and postnatal brain growth in critical congenital heart disease. J Thorac Cardiovasc Surg, 2018, 155(1): 291-300.
14. Peyvandi S, De Santiago V, Chakkarapani E, et al. Association of prenatal diagnosis of critical congenital heart disease with postnatal brain development and the risk of brain injury. JAMA Pediatr, 2016, 170(4): e154450.
15. Li Y, Yin S, Fang J, et al. Neurodevelopmental delay with critical congenital heart disease is mainly from prenatal injury not infant cardiac surgery: Current evidence based on a meta-analysis of functional magnetic resonance imaging. Ultrasound Obstet Gynecol, 2015, 45(6): 639-648.
16. Limperopoulos C, Tworetzky W, McElhinney DB, et al. Brain volume and metabolism in fetuses with congenital heart disease: Evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation, 2010, 121(1): 26-33.
17. Marino BS, Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: Evaluation and management: A scientific statement from the American Heart Association. Circulation, 2012, 126(9): 1143-1172.
18. Keir M, Ebert P, Kovacs AH, et al. Neurocognition in adult congenital heart disease: How to monitor and prevent progressive decline. Can J Cardiol, 2019, 35(12): 1675-1685.
19. Marelli A, Miller SP, Marino BS, et al. Brain in congenital heart disease across the lifespan: The cumulative burden of injury. Circulation, 2016, 133(20): 1951-1962.
20. Dimitropoulos A, McQuillen PS, Sethi V, et al. Brain injury and development in newborns with critical congenital heart disease. Neurology, 2013, 81(3): 241-248.
21. Lynch JM, Ko T, Busch DR, et al. Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease. J Thorac Cardiovasc Surg, 2018, 156(4): 1657-1664.
22. Andropoulos DB, Hunter JV, Nelson DP, et al. Brain immaturity is associated with brain injury before and after neonatal cardiac surgery with high-flow bypass and cerebral oxygenation monitoring. J Thorac Cardiovasc Surg, 2010, 139(3): 543-556.
23. Bertholdt S, Latal B, Liamlahi R, et al. Cerebral lesions on magnetic resonance imaging correlate with preoperative neurological status in neonates undergoing cardiopulmonary bypass surgery. Eur J Cardiothorac Surg, 2014, 45(4): 625-632.
24. Mahle WT, Tavani F, Zimmerman RA, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation, 2002, 106(12 Suppl 1): I109-I114.
25. Back SA, Miller SP. Brain injury in premature neonates: A primary cerebral dysmaturation disorder? Ann Neurol, 2014, 75(4): 469-486.
26. Fontes K, Rohlicek CV, Saint-Martin C, et al. Hippocampal alterations and functional correlates in adolescents and young adults with congenital heart disease. Hum Brain Mapp, 2019, 40(12): 3548-3560.
27. Kessler N, Feldmann M, Schlosser L, et al. Structural brain abnormalities in adults with congenital heart disease: Prevalence and association with estimated intelligence quotient. Int J Cardiol, 2020, 306: 61-66.
28. Poels MM, Ikram MA, van der Lugt A, et al. Incidence of cerebral microbleeds in the general population: The Rotterdam Scan Study. Stroke, 2011, 42(3): 656-661.
29. Liu YH, Wang DX, Li LH, et al. The effects of cardiopulmonary bypass on the number of cerebral microemboli and the incidence of cognitive dysfunction after coronary artery bypass graft surgery. Anesth Analg, 2009, 109(4): 1013-1022.
30. Bagge CN, Henderson VW, Laursen HB, et al. Risk of dementia in adults with congenital heart disease: Population-based cohort study. Circulation, 2018, 137(18): 1912-1920.
31. Jackson JL, Leslie CE, Hondorp SN. Depressive and anxiety symptoms in adult congenital heart disease: Prevalence, health impact and treatment. Prog Cardiovasc Dis, 2018, 61(3-4): 294-299.
32. Desai R, Patel K, Dave H, et al. Nationwide frequency, sequential trends, and impact of co-morbid mental health disorders on hospitalizations, outcomes, and healthcare resource utilization in adult congenital heart disease. Am J Cardiol, 2020, 125(8): 1256-1262.
33. Lei Lei E, Ladha K, Mueller B, et al. Noncardiac determinants of death and intensive care morbidity in adult congenital heart disease surgery. J Thorac Cardiovasc Surg, 2020, 159(6): 2407-2415.
34. Lanz J, Brophy JM, Therrien J, et al. Stroke in adults with congenital heart disease: Incidence, cumulative risk, and predictors. Circulation, 2015, 132(25): 2385-2394.
35. Singh S, Desai R, Fong HK, et al. Extra-cardiac comorbidities or complications in adults with congenital heart disease: A nationwide inpatient experience in the United States. Cardiovasc Diagn Ther, 2018, 8(6): 814-819.
36. Billett J, Cowie MR, Gatzoulis MA, et al. Comorbidity, healthcare utilisation and process of care measures in patients with congenital heart disease in the UK: Cross-sectional, population-based study with case-control analysis. Heart, 2008, 94(9): 1194-1199.
37. Williamson JD, Pajewski NM, Auchus AP, et al. Effect of intensive vs standard blood pressure control on probable dementia: A randomized clinical trial. JAMA, 2019, 321(6): 553-561.
38. Lachmann G, Feinkohl I, Borchers F, et al. Diabetes, but not hypertension and obesity, is associated with postoperative cognitive dysfunction. Dement Geriatr Cogn Disord, 2018, 46(3-4): 193-206.
39. Feinkohl I, Winterer G, Pischon T. Hypertension and risk of post-operative cognitive dysfunction (POCD): A systematic review and meta-analysis. Clin Pract Epidemiol Ment Health, 2017, 13: 27-42.
40. Jefferson AL, Himali JJ, Beiser AS, et al. Cardiac index is associated with brain aging: The Framingham Heart Study. Circulation, 2010, 122(7): 690-697.
41. Sabayan B, van Buchem MA, Sigurdsson S, et al. Cardiac hemodynamics are linked with structural and functional features of brain aging: The age, gene/environment susceptibility (AGES)-Reykjavik Study. J Am Heart Assoc, 2015, 4(1): e001294.
42. Cannon JA, Moffitt P, Perez-Moreno AC, et al. Cognitive impairment and heart failure: Systematic review and meta-analysis. J Card Fail, 2017, 23(6): 464-475.
43. Bouchardy J, Therrien J, Pilote L, et al. Atrial arrhythmias in adults with congenital heart disease. Circulation, 2009, 120(17): 1679-1686.
44. Kwok CS, Loke YK, Hale R, et al. Atrial fibrillation and incidence of dementia: A systematic review and meta-analysis. Neurology, 2011, 76(10): 914-922.
45. Avidan MS, Evers AS. Review of clinical evidence for persistent cognitive decline or incident dementia attributable to surgery or general anesthesia. J Alzheimers Dis, 2011, 24(2): 201-216.
46. Holmgaard F, Vedel AG, Rasmussen LS, et al. The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: A secondary analysis of a randomised trial. Br J Anaesth, 2019, 123(2): 196-205.
47. Kumpaitiene B, Svagzdiene M, Drigotiene I, et al. Correlation among decreased regional cerebral oxygen saturation, blood levels of brain injury biomarkers, and cognitive disorder. J Int Med Res, 2018, 46(9): 3621-3629.
48. Kok WF, Koerts J, Tucha O, et al. Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery. Anaesthesia, 2017, 72(3): 359-369.
49. Yu Y, Zhang K, Zhang L, et al. Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database Syst Rev, 2018, 1(1): Cd010947.
50. Vedel AG, Holmgaard F, Rasmussen LS, et al. High-target versus low-target blood pressure management during cardiopulmonary bypass to prevent cerebral injury in cardiac surgery patients: A randomized controlled trial. Circulation, 2018, 137(17): 1770-1780.

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