Vascular Endothelial Dysfunction, Cognition and Stroke in Early Life Study (VECSELS)

Objectives The first objective of the study is to demonstrate that children with congenital heart disease (CHD) and a history of arterial ischemic stroke (AIS) have abnormal perfusion in the contralesional hemisphere, and these observations are associated with specific cognitive impairments. The second objective is to demonstrate a spectrum of vascular endothelial dysfunction (VED) associated with cognitive function among children with CHD with and without a history of AIS.

Methods This study has two arms. The cross-sectional arm addresses the first objective and compares magnetic resonance perfusion using the apparent diffusion coefficient (ADC) obtained for each subject and cognitive outcomes in a cohort of cardiac stroke patients. The prospective arm of the study addresses the second objective by assessing VED. VED and neuropsychological evaluation scores will be compared between patients with CHD with and without a history of AIS.

Results Preliminary results from 3 patients in the cardiac stroke cohort and 3 age-matched controls in the cross-sectional arm show that the patient cohort scored below average on most outcome sub-tests. Interestingly, processing speed (M=87.7, SD=26.4) and global executive composite (M=61, SD=13.5) scores display a spectrum of impairment that correspond to a spectrum of ADCs. The ADC values (mm2/s x 10-3) in both the ipsilesional (M=0.83, SD=0.03) and contralesional (M=0.84, SD=0.05) hemisphere of cardiac stroke patients were elevated compared to controls.

Conclusions This preliminary data suggests that specific cognitive outcomes may be moderated by global hypoperfusion and a gradient of VED in CHD patients with and without a history of AIS.
Keywords: stroke, congenital heart disease, perfusion, neuroimaging, outcomes