Resting-state functional connectivity in comatose patients after cardiac arrest in relation to outcome
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2021-07-16
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en
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Early prognostication of comatose patients after cardiac arrest is challenging and current multimodal approaches leave the majority of patients with an indeterminate prognosis. We investigated whether resting-state functional magnetic resonance imaging (MRI) at three days after cardiac arrest is associated with neurological outcome after three months in comatose patients. We performed a prospective multicentre cohort study in comatose patients after cardiac arrest submitted to the Intensive Care Unit of two Dutch hospitals. MRI was performed at 3±1 days after cardiac arrest, including functional MRI (fMRI) and diffusion-weighted imaging. Continuous electroencephalography (EEG) was recorded during the first three days. Resting-state fMRI was used to quantify functional connectivity within and between resting-state networks. Associations between functional connectivity, mean diffusivity and EEG-based prediction were explored. We included 48 comatose patients after cardiac arrest, of whom 28 (58%) with good outcome. Patients with poor outcome show reduced within-network connectivity compared to patients with good outcome, most prominent in the default-mode network (DMN), salience network (SN), frontoparietal (FPN) and visual network. Between-network connectivity of SN-FPN was reduced in patients with a poor outcome. Mean diffusivity within all identified functional networks was reduced in patients with poor versus good outcome. In patients with an uncertain EEG-based prognosis, the two outcome groups approximately form fMRI-based clusters. We conclude that reduced resting-state functional connectivity in comatose patients after cardiac arrest is associated with poor neurological recovery after three months. This group difference is complementary to changes in mean diffusivity and EEG, specifically in patients with an uncertain prognosis.
Keywords: Postanoxic coma; functional MRI; EEG; Diffusion Weighted Imaging; Cardiac arrest
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Faculteit der Sociale Wetenschappen