White Matter Volume Predicts Language Development in Congenital Heart Disease

Abstract

Objective: To determine whether brain volume is reduced at 1 year of age and whether these volumes are associated with neurodevelopment in biventricular congenital heart disease (CHD) repaired in infancy.

Study design: Infants with biventricular CHD (n = 48) underwent brain magnetic resonance imaging (MRI) and neurodevelopmental testing with the Bayley Scales of Infant Development-II and the MacArthur-Bates Communicative Development Inventories at 1 year of age. A multitemplate based probabilistic segmentation algorithm was applied to volumetric MRI data. We compared volumes with those of 13 healthy control infants of comparable ages. In the group with CHD, we measured Spearman correlations between neurodevelopmental outcomes and the residuals from linear regression of the volumes on corrected chronological age at MRI and sex.

Results: Compared with controls, infants with CHD had reductions of 54 mL in total brain (P = .009), 40 mL in cerebral white matter (P <.001), and 1.2 mL in brainstem (P = .003) volumes. Within the group with CHD, brain volumes were not correlated with Bayley Scales of Infant Development-II scores but did correlate positively with MacArthur-Bates Communicative Development Inventory language development.

Conclusions: Infants with biventricular CHD show total brain volume reductions at 1 year of age, driven by differences in cerebral white matter. White matter volume correlates with language development, but not broader developmental indices. These findings suggest that abnormalities in white matter development detected months after corrective heart surgery may contribute to language impairment.

Trial registration: ClinicalTrials.gov: NCT00006183.

Keywords: MRI; brain; infant; language; neurodevelopment.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Regression lines and 95% confidence intervals showing the associations between MacArthur- Bates Communicative Development Inventories (CDI) percentiles and cerebral white matter volume. Cerebral white matter volume was adjusted for corrected chronological age and sex by adding the mean value of cerebral white matter volume for the 38 cardiac patients to the residuals from linear regression of the volume on corrected chronological age and sex. CDI percentiles increase as cerebral white matter volume increases (adjusted Spearman correlation r = 0.43, P = 0.008, Panel A for vocabulary words understood; r = 0.44, P = 0.006, Panel B for total gestures).