The cumulative impact of clinical risk factors on structural brain networks and executive functions in adolescents with congenital heart disease

Motivation: Congenital heart disease (CHD) negatively impacts brain development and cognition. Goal(s): We aim to elucidate the role of clinical and environmental factors on brain development and cognition. Approach: A cumulative clinical risk (CCR) score derived from neonatal, cardiac, and neurological variables, brain connectivity metrics using diffusion-MRI, and cognitive outcomes were obtained in 53 CHD adolescents and 75 controls. Results: Higher CCR scores correlated with weaker brain network strength in a fronto-parietal-thalamic network, lower network segregation and poorer cognitive function, independent of family-environmental factors. These findings underscore the need for early risk assessment to predict brain development and aid vulnerable adolescents with CHD. Impact: Adolescents with congenital heart disease demonstrate altered brain networks, particularly those who face a cumulative exposure to multiple risk factors over time. Early assessment of risk load could help predict brain development and support the most vulnerable patients early on.