Short-Term CBF and FC Response to Moderate Exercise Differs in Congenital Heart Disease Patients
Poster No:
2592
Submission Type:
Abstract Submission
Authors:
Vanessa Schmithorst1, Aurelia Sahel2, Vince Lee1, Julia Wallace2, Ashok Panigrahy2
Institutions:
1UPMC Children's Hospital, Pittsburgh, PA, 2UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
First Author:
Co-Author(s):
Introduction:
Aerobic exercise causes short-term changes in cerebral blood flow (CBF) (Querido & Sheel, 2007; Olivo et al., 2021) and functional connectivity (Ko et al., 2023); and long-term neurocognitive benefits (Colcombe & Kramer, 2003) mediated by vascular changes (Hillman et al., 2008). Congenital heart disease (CHD) patients show neurocognitive deficits in a variety of domains (Donofrio & Massaro, 2010) and aerobic exercise may be a promising intervention. We investigated the short-term effects of moderate intensity exercise on CBF and functional connectivity strength (FCS), in CHD patients and normal controls.
Methods:
Participants were10 normal controls (age = 23.3 +/- 4.0 years, 7 M, 3 F) and 7 CHD patients (age = 27.7 +/= 6.4 years, 2 M, 5 F). Participants exercised for 15 minutes on a cycle ergometer preceded and followed by 3-minute warm up and cool down periods. Peak exercise intensity was performed at 60-70% of the maximum predicted heart rate (estimated as 220 – age(yrs)).
Images were obtained on a 3 T Siemens Skyra scanner. PCASL: 2D-EPI, resolution = 4 X 4 X 4 mm, label duration = 1500 ms, post-label delay = 1500 ms, 45 label/tag image pairs acquired. BOLD: 2D-EPI, resolution = 4 X 4 X 4 mm, TE = 30 ms, TR = 2000 ms (MB factor = 1) / 800 ms (MB factor = 4). For the CHD participants, the MB factor was chosen as either 1 or 4 dependent on the presence of a metal shunt (MB factor > 1 being prohibited in these cases). For the controls, MB factor was randomized to either 1 or 4. Functional connectivity strength (FCS) maps and CBF maps were computed and spatially coregistered.
A mixed-effects general linear model (GLM) was performed on a voxelwise basis investigating main effect of session (pre- or post-exercise) and CHD status X session interaction. Age and sex were included as covariates for all analyses. For CBF, GM probability was also included as a covariate. For FCS, MB factor and total number of frames acquired (square root) were included as covariates of no interest. Standard methods were used to correct for multiple comparisons (FWE).
Images were obtained on a 3 T Siemens Skyra scanner. PCASL: 2D-EPI, resolution = 4 X 4 X 4 mm, label duration = 1500 ms, post-label delay = 1500 ms, 45 label/tag image pairs acquired. BOLD: 2D-EPI, resolution = 4 X 4 X 4 mm, TE = 30 ms, TR = 2000 ms (MB factor = 1) / 800 ms (MB factor = 4). For the CHD participants, the MB factor was chosen as either 1 or 4 dependent on the presence of a metal shunt (MB factor > 1 being prohibited in these cases). For the controls, MB factor was randomized to either 1 or 4. Functional connectivity strength (FCS) maps and CBF maps were computed and spatially coregistered.
A mixed-effects general linear model (GLM) was performed on a voxelwise basis investigating main effect of session (pre- or post-exercise) and CHD status X session interaction. Age and sex were included as covariates for all analyses. For CBF, GM probability was also included as a covariate. For FCS, MB factor and total number of frames acquired (square root) were included as covariates of no interest. Standard methods were used to correct for multiple comparisons (FWE).
Results:
Decreases in CBF were seen (Figure 1, left) in prefrontal/medial frontal cortex, insula, putamen, as well as sensory regions. Increases were seen in the right cerebellum and fusiform/lingual gyri. Significant interactions were seen mainly in posterior regions (Figure 1, right) but also in the cerebellum and fusiform/lingual gyri.
FCS increases were seen (Figure 2, left) in the inferior and superior parietal lobules, the inferior temporal lobe, and the superior temporal gyrus. FCS decreases were seen in the posterior DMN, supplementary motor cortex, and visual association areas (lingual gyrus/middle occipital gyrus). Positive interactions were seen (Figure 2, right) mainly in the basal ganglia (putamen/caudate) and thalamus, inferior temporal gyrus and supramarginal gyrus. Negative interactions were seen in the cuneus/precuneus, prefrontal cortex and inferior occipital lobe.
FCS increases were seen (Figure 2, left) in the inferior and superior parietal lobules, the inferior temporal lobe, and the superior temporal gyrus. FCS decreases were seen in the posterior DMN, supplementary motor cortex, and visual association areas (lingual gyrus/middle occipital gyrus). Positive interactions were seen (Figure 2, right) mainly in the basal ganglia (putamen/caudate) and thalamus, inferior temporal gyrus and supramarginal gyrus. Negative interactions were seen in the cuneus/precuneus, prefrontal cortex and inferior occipital lobe.
·Figure 1. (Left) Regions with increased (hot colors) or decreased (cold colors) CBF after exercise. (Right) Regions with CHD status - X - session interactions.
·Figure 2. (Left) Regions with increased (hot colors) or decreased (cold colors) FCS after exercise. (Right) Regions with CHD status - X - session interactions.
Conclusions:
Our results agree with previous reports (Querido & Sheel, 2007) showing overall CBF reductions after exercise likely due to vasoconstriction subsequent to hypercapnia. CHD patients show less CBF reductions in regions supplied via the cortical branches of the posterior carotid artery (PCA), which may indicate increased stiffness and less cerebrovascular reactivity in CHD patients (Hou et al., 2015; Sandhu et al., 2021).
Our results also show increased FCS after exercise mainly in primary motor and sensory processing regions but decreased FCS primarily in the posterior DMN. CHD patients display increased FCS in the basal ganglia and thalamus after exercise, while showing less effects in the DMN and visual processing regions. Increased cerebellar-thalamic and thalamic-prefrontal connectivity has been previously shown in CHD patients (Sahel et al., 2023). The impact of these differences on long-term effects of exercise in CHD patients will be investigated in future research.
Our results also show increased FCS after exercise mainly in primary motor and sensory processing regions but decreased FCS primarily in the posterior DMN. CHD patients display increased FCS in the basal ganglia and thalamus after exercise, while showing less effects in the DMN and visual processing regions. Increased cerebellar-thalamic and thalamic-prefrontal connectivity has been previously shown in CHD patients (Sahel et al., 2023). The impact of these differences on long-term effects of exercise in CHD patients will be investigated in future research.
Brain Stimulation:
Non-Invasive Stimulation Methods Other
Higher Cognitive Functions:
Executive Function, Cognitive Control and Decision Making
Modeling and Analysis Methods:
Connectivity (eg. functional, effective, structural) 2
Physiology, Metabolism and Neurotransmission :
Cerebral Metabolism and Hemodynamics 1
Keywords:
ADULTS
Cerebral Blood Flow
FUNCTIONAL MRI
Motor
1|2Indicates the priority used for review
Provide references using author date format
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Ko, Y. W., S. M. Kim, K. D. Kang and D. H. Han (2023). "Changes in Functional Connectivity Between Default Mode Network and Attention Network in Response to Changes in Aerobic Exercise Intensity." Psychiatry Investig 20(1): 27-34.
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