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Alrashidi AA, Nightingale TE, Currie KD, Hubli M, MacDonald MJ, Hicks AL, Oh P, Craven BC, Krassioukov AV. Exercise Improves Cardiorespiratory Fitness, but Not Arterial Health, after Spinal Cord Injury: The CHOICES Trial. J Neurotrauma 2021; 38:3020-3029. [PMID: 34314235 DOI: 10.1089/neu.2021.0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), is elevated after spinal cord injury (SCI). In the uninjured population, exercise training has been shown to reduce arterial stiffness. In a randomized, multi-center clinical trial, we evaluated the impact of two exercise interventions on cardiovascular disease risk factors in persons with chronic SCI. A total of 46 adults with motor-complete SCI with neurological levels of injury between the fourth cervical and sixth thoracic spinal cord segments (C4-T6) were randomly assigned to either body-weight-supported treadmill training (BWSTT) or arm-cycle ergometer training (ACET). Participants trained 3 days per week for 24 weeks. Exercise session duration progressed gradually to reach 30 and 60 min for ACET and BWSTT, respectively. The primary outcome was arterial stiffness, assessed by cfPWV, and was measured at baseline, 12 weeks of training, and at 24 weeks. Secondary outcomes included cardiorespiratory fitness (CRF) and cardiometabolic health measures and were measured before and after completion of training. Fourteen participants per intervention arm completed the exercise intervention. Our results show no effect of either exercise intervention on arterial stiffness (p = 0.07) and cardiometabolic health measures (p > 0.36). However, peak oxygen uptake increased with ACET compared with BWSTT (p = 0.04). The findings of this trial demonstrate that although 24 weeks of upper-body exercise improved CRF in persons with motor-complete SCI ≥T6, neither intervention resulted in improvements in arterial stiffness or cardiometabolic health measures. ClinicalTrials.gov identifier: NCT01718977.
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Affiliation(s)
- Abdullah A Alrashidi
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Department of Physical Therapy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Katharine D Currie
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Michèle Hubli
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Audrey L Hicks
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Paul Oh
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Beverley Catharine Craven
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Williams AM, Ma JK, Martin Ginis KA, West CR. Effects of a Tailored Physical Activity Intervention on Cardiovascular Structure and Function in Individuals With Spinal Cord Injury. Neurorehabil Neural Repair 2021; 35:692-703. [PMID: 34027716 PMCID: PMC8704204 DOI: 10.1177/15459683211017504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Spinal cord injury (SCI) leads to a loss of descending motor and sympathetic control below the level of injury (LOI), which ultimately results in chronically altered cardiovascular function and remodeling. While supervised, laboratory-based exercise training can generate cardiovascular adaptations in people with SCI, it is unknown whether behavioral community-based interventions effectively generate such adaptations for individuals with SCI. Objective Examine the effects of a tailored behavioral physical activity (PA) intervention on cardiac and vascular structure and function in individuals with SCI. Methods In this randomized controlled trial, 32 participants with SCI (18-65 years, SCI >1 year) were assigned to PA (8-week behavioral intervention) or control (CON) groups. At baseline and postintervention, measures of resting left ventricular (LV) structure and function, carotid intima-media thickness and pulse-wave velocity were assessed with ultrasound and tonometry. Results Twenty-eight participants completed the study (n = 14/group). Across the full study cohort there were no significant changes in indices of LV or vascular structure and function, despite notable improvements in peak power and oxygen uptake in the PA group. However, in a subanalysis for LOI, individuals in the PA group with LOIs below T6 had evidence of altered LV geometry (ie, increased LV internal diameter, reduced sphericity index and relative wall thickness; group × time P < 0.05 for all), which was not seen in individuals with higher LOIs at or above T6. Conclusion An 8-week behavioral PA intervention appears to promote adaptations in cardiac geometry more readily in individuals with lower level SCI than those with higher-level SCI.
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Affiliation(s)
| | - Jasmin K Ma
- University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Kathleen A Martin Ginis
- University of British Columbia, Vancouver, British Columbia, Canada.,University of British Columbia, Kelowna, British Columbia, Canada
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Katzelnick CG, Weir JP, Pinto Zipp G, LaFountaine MF, Bauman WA, Dyson-Hudson TA, Wecht JM. Increased pulse wave velocity in persons with spinal cord injury: the effect of the renin-angiotensin-aldosterone system. Am J Physiol Heart Circ Physiol 2020; 320:H272-H280. [PMID: 33095646 DOI: 10.1152/ajpheart.00544.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increased pulse wave velocity (PWV), a marker of cardiovascular disease (CVD), has been reported in otherwise healthy individuals with spinal cord injury (SCI) compared with age-matched uninjured controls. Due to decentralized descending sympathetic vascular control, individuals with injuries above T6 are prone to orthostatic hypotension and, as a result, depend on the renin-angiotensin-aldosterone system (RAAS) to maintain orthostatic blood pressure (BP). The purpose of this study was to determine resting PWV, a noninvasive surrogate of central arterial stiffness, in individuals with cervical (C4-T1; n = 11) and thoracic (T6-T12; n = 11) SCI, compared with age-matched controls (controls; n = 11). Next, our aim was to describe group differences in BP, plasma norepinephrine (NE), and renin response to head-up tilt (HUT). Finally, we sought to determine the relationship between PWV and the orthostatic change in BP, NE, and the plasma renin during HUT among the groups. PWV was significantly increased in both cervical (8.81 ± 1.91 m/s) and thoracic (7.36 ± 1.58 m/s) SCI compared with the controls (5.53 ± 0.95 m/s; P < 0.05). The change from supine to 60° HUT in BP and NE was significantly reduced and change in plasma renin was significantly increased in the cervical group compared with the thoracic and control groups. Group affiliation and change in plasma renin were significant predictors of PWV (R2 = 0.63, P = 0.001). These data suggest that dependency on the RAAS for orthostatic BP maintenance may be associated with increased PWV and risk of CVD in the SCI population.NEW & NOTEWORTHY Our novel findings suggest that increased arterial stiffness in individuals with SCI may be due to greater dependency on the RAAS to maintain hemodynamic stability during an orthostatic challenge. Asymptomatic orthostatic hypotension can occur in persons with SCI during transition from the supine to the seated position and during other upright activities of daily living; however, it is seldom addressed by clinicians.
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Affiliation(s)
- Caitlyn G Katzelnick
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Kessler Foundation, West Orange, New Jersey.,Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Genevieve Pinto Zipp
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey
| | - Michael F LaFountaine
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey.,Department of Medical Sciences and Neurology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey.,Icahn School of Medicine at Mount Sinai, New York City, New York
| | - William A Bauman
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jill M Wecht
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
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Associations between arterial stiffness and blood pressure fluctuations after spinal cord injury. Spinal Cord 2019; 57:1057-1063. [DOI: 10.1038/s41393-019-0316-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022]
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Krassioukov AV, Currie KD, Hubli M, Nightingale TE, Alrashidi AA, Ramer L, Eng JJ, Ginis KAM, MacDonald MJ, Hicks A, Ditor D, Oh P, Verrier MC, Craven BC. Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study]. BMJ Open 2019; 9:e023540. [PMID: 30612110 PMCID: PMC6326283 DOI: 10.1136/bmjopen-2018-023540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid-to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population. Therefore, this study aims to compare the efficacy of arm cycle ergometry training (ACET) and body weight-supported treadmill training (BWSTT) on reducing arterial stiffness in individuals with chronic motor complete, high-level (above the sixth thoracic segment) SCI. METHODS AND ANALYSIS This is a multicentre, randomised, controlled, clinical trial. Eligible participants will be randomly assigned (1:1) into either ACET or BWSTT groups. Sixty participants with chronic (>1 year) SCI will be recruited from three sites in Canada (Vancouver, Toronto and Hamilton). Participants in each group will exercise three times per week up to 30 min and 60 min for ACET and BWSTT, respectively, over the period of 6 months. The primary outcome measure will be change in arterial stiffness (cfPWV) from baseline. Secondary outcome measures will include comprehensive assessments of: (1) cardiovascular parameters, (2) autonomic function, (3) body composition, (4) blood haematological and metabolic profiles, (5) cardiorespiratory fitness and (6) quality of life (QOL) and physical activity outcomes. Outcome measures will be assessed at baseline, 3 months, 6 months and 12 months (only QOL and physical activity outcomes). Statistical analyses will apply linear-mixed modelling to determine the training (time), group (ACET vs BWSTT) and interaction (time × group) effects on all outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated. TRIAL REGISTRATION NUMBER NCT01718977; Pre-results. TRIAL STATUS Recruitment for this study began on January 2013 and the first participant was randomized on April 2013. Recruitment stopped on October 2018.
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Affiliation(s)
- Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Katharine D Currie
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Michèle Hubli
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Balgrist University Hospital, University of Zurich, Zurich, Swaziland
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah A Alrashidi
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Therapy Department, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Leanne Ramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Janice J Eng
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen A Martin Ginis
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Southern Medical Program, School of Health & Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Audrey Hicks
- Spinal Cord Injury Centre, McMaster University, Hamilton, Ontario, Canada
| | - Dave Ditor
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Paul Oh
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Molly C Verrier
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Beverly Catharine Craven
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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Lee AHX, Phillips AA, Krassioukov AV. Increased Central Arterial Stiffness after Spinal Cord Injury: Contributing Factors, Implications, and Possible Interventions. J Neurotrauma 2017; 34:1129-1140. [DOI: 10.1089/neu.2016.4694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Amanda H. X. Lee
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- Experimental Medicine Program, Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron A. Phillips
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- Experimental Medicine Program, Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- Experimental Medicine Program, Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Vascular health toolbox for spinal cord injury: Recommendations for clinical practice. Atherosclerosis 2015; 243:373-82. [DOI: 10.1016/j.atherosclerosis.2015.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022]
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Hubli M, Currie KD, West CR, Gee CM, Krassioukov AV. Physical exercise improves arterial stiffness after spinal cord injury. J Spinal Cord Med 2014; 37:782-5. [PMID: 24976366 PMCID: PMC4231967 DOI: 10.1179/2045772314y.0000000232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE/BACKGROUND Aortic pulse wave velocity (PWV), the gold-standard assessment of central arterial stiffness, has prognostic value for cardiovascular disease risk in able-bodied individuals. The aim of this study was to compare aortic PWV in athletes and non-athletes with spinal cord injury (SCI). DESIGN Cross-sectional comparison. METHODS Aortic PWV was assessed in 20 individuals with motor-complete, chronic SCI (C2-T5; 18 ± 8 years post-injury) using applanation tonometry at the carotid and femoral arterial sites. Ten elite hand-cyclists were matched for sex to 10 non-athletes; age and time since injury were comparable between the groups. Heart rate and discrete brachial blood pressure measurements were collected throughout testing. OUTCOME MEASURES Aortic PWV, blood pressure, heart rate. RESULTS Aortic PWV was significantly lower in athletes vs. non-athletes (6.9 ± 1.0 vs. 8.7 ± 2.5 m/second, P = 0.044). There were no significant between-group differences in resting supine mean arterial blood pressure (91 ± 19 vs. 81 ± 10 mmHg) and heart rate (60 ± 10 vs. 58 ± 6 b.p.m.). CONCLUSION Athletes with SCI exhibited improved central arterial stiffness compared to non-athletes, which is in agreement with the previous able-bodied literature. This finding implies that chronic exercise training may improve arterial health and potentially lower cardiovascular disease risk in the SCI population.
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Affiliation(s)
- Michèle Hubli
- ICORD, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Katharine D. Currie
- ICORD, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher R. West
- ICORD, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cameron M. Gee
- ICORD, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V. Krassioukov
- Correspondence to: Andrei V. Krassioukov, ICORD-BSCC, Department of Medicine, University of British Columbia, 818 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9.
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Miyatani M, Szeto M, Moore C, Oh PI, McGillivray CF, Catharine Craven B. Exploring the associations between arterial stiffness and spinal cord impairment: A cross-sectional study. J Spinal Cord Med 2014; 37:556-64. [PMID: 25229737 PMCID: PMC4166190 DOI: 10.1179/2045772314y.0000000261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/OBJECTIVE Elevated aortic arterial stiffness (aortic pulse wave velocity: aPWV) is an independent coronary artery disease predictor among the general population. The purpose of this study was to: (1) report aPWV values in a representative cohort of patients with spinal cord injury (SCI); (2) to compare aPWV values in people with SCI based on neurological level of injury; and (3) to contrast the reported aPWV values with available normal values for the general population. METHODS Adults with chronic SCI (n = 87) were divided into two groups (TETRA group, n = 37 and PARA group, n = 50). aPWV and potential confounders of aPWV were assessed. Analysis of covariance was used for comparisons between groups and adjusted for the confounders. Subjects' aPWV values were contrasted with reference values for general population determined by "The Reference value for arterial stiffness' collaboration" and prevalence of abnormal aPWV defined as greater than or equal to the age-specific 90th percentile was reported. RESULTS Prevalence of abnormal aPWV in the cohort was 25.3%. After adjusting for covariates, the mean aPWV values were significantly different between two groups (TETRA: 8.0 (95% confidence interval (CI): 7.5-8.6) m/second, PARA: 9.0 (95% CI: 8.5-9.4) m/second, P = 0.010). The prevalence of abnormal aPWV was significantly higher in the PARA group (36%) compared to the TETRA group (11%) (P = 0.012). CONCLUSIONS One-quarter of the total cohort had an abnormal aPWV. Subjects with paraplegia had higher aPWV values and a higher frequency of abnormal aPWV than subjects with tetraplegia. Elevated aPWV in people with SCI, particularly those with paraplegia, may impart significant adverse cardiovascular consequences.
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Affiliation(s)
- Masae Miyatani
- Toronto Rehabilitation Institute-UHN, Brain and Spinal Cord Rehabilitation Program, Toronto, ON, Canada,Correspondence to: Masae Miyatani, Lyndhurst Centre, Toronto Rehabilitation Institute-UHN, 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada.
| | - Maggie Szeto
- Toronto Rehabilitation Institute-UHN, Brain and Spinal Cord Rehabilitation Program, Toronto, ON, Canada
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Microflotronic arterial tonometry for continuous wearable non-invasive hemodynamic monitoring. Ann Biomed Eng 2014; 42:2278-88. [PMID: 24889715 DOI: 10.1007/s10439-014-1037-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
Personalized mobile medicine will continue to advance through the development of wearable sensors that can wirelessly provide pertinent health information while remaining unobtrusive, comfortable, low cost, and easy to operate and interpret. It is the intention that the sensor presented hereafter can contribute to such innovation. By applying a combination of emerging microfluidic and electronic technologies, a miniature, flexible, transparent, highly sensitive and wearable pressure sensor with microfluidic elements has been implemented, referred to as a microflotronic device. High sensitivity of 0.1 kPa(-1) and fast response time on the order of tens of milliseconds has been achieved on the microflotronic sensor design. Its sensitivity is among the highest in impedance-based flexible pressure sensors. Once configured into an array, the transparent device can be easily aligned over the target artery to measure blood pressure noninvasively and continuously. In addition, the ultraflexible and thin plastic construct of the microflotronic sensor (of 270 µm in height) can be worn comfortably for extended periods of time. Importantly, the proposed microflotronic sensor has been utilized to perform arterial tonometry with the capability of noninvasive monitoring of arterial blood pressure waveforms in a real-time and continuous fashion.
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