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Mazur MD, Hamner JW, Anand AN, Taylor JA. Cardiorespiratory Effects of Yogic Versus Slow Breathing in Individuals with a Spinal Cord Injury: An Exploratory Cohort Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38507692 DOI: 10.1089/jicm.2023.0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background: An intricate physiological and pathophysiological connection exists between the heart and lungs, which is especially important in individuals with spinal cord injury (SCI). While an exercise intervention may seem the best approach to leverage this relationship, the prior work has shown that, despite numerous health benefits, regular exercise training does not improve cardiorespiratory control in individuals with SCI. Breath training presents an alternative intervention that is uniquely accessible, with yogic breathing directly engaging linked fluctuations in respiration and cardiovascular control. In addition, there is evidence across a range of populations that regular yogic breathing reduces cardiovascular disease risk. It is possible that the chronic decrease in breathing frequency associated with regular yogic breathing, rather than the specific yogic breathing techniques themselves, is the primary contributor to the observed risk reduction. Methods: Therefore, in 12 individuals with traumatic SCI from C4 to T8, the authors compared Unpaced and conventional 0.083 Hz (Slow) paced breathing with various yogic breathing techniques including: (1) inspiratory-expiratory breath holds (i.e., Kumbhaka or "Box Breathing"), (2) extended exhalation (1:2 duty cycle), and (3) expiratory resistance via throat constriction (i.e., Ujjayi). Beat-to-beat heart rate and blood pressure were measured as well as end-tidal CO2 and O2 saturation were measured. Statistical analysis was performed using a one-way repeated-measures analysis of variance with post hoc pairwise t tests corrected for multiple comparisons. Results: As expected, all slow breathing patterns markedly increased respiratory sinus arrhythmia (RSA) compared with Unpaced in all (n = 12) individuals. More importantly, Ujjayi breathing appeared to improve ventilatory efficiency over Unpaced breathing in individuals with SCI by increasing O2 saturation (97.6% vs. 96.1%; p = 0.042) and tended to decrease end-tidal CO2 (32 mmHg vs. 35 mmHg; p = 0.08). While other slow breathing patterns demonstrated similar effects, only Ujjayi improved RSA while increasing heart rate and improving ventilatory efficiency. Conclusions: Hence, slow breathing per se can result in important cardiorespiratory changes, but the yogic breathing practice of Ujjayi, with glottic throat resistance, may hold the greatest promise for improving cardiorespiratory control in individuals with SCI (CTR ID No. NCT05480618).
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Affiliation(s)
- Marc D Mazur
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, USA
| | - Jason W Hamner
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, USA
| | - Amit N Anand
- St. Elizabeth's Medical Center, Brighton, MA, USA
| | - J Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA, USA
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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Schoffl J, Arora M, Pozzato I, McBain C, Rodrigues D, Vafa E, Middleton J, Davis GM, Gustin SM, Bourke J, Kifley A, Krassioukov AV, Cameron ID, Craig A. Heart Rate Variability Biofeedback in Adults with a Spinal Cord Injury: A Laboratory Framework and Case Series. J Clin Med 2023; 12:7664. [PMID: 38137732 PMCID: PMC10743967 DOI: 10.3390/jcm12247664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Heart rate variability biofeedback (HRV-F) is a neurocardiac self-regulation therapy that aims to regulate cardiac autonomic nervous system activity and improve cardiac balance. Despite benefits in various clinical populations, no study has reported the effects of HRV-F in adults with a spinal cord injury (SCI). This article provides an overview of a neuropsychophysiological laboratory framework and reports the impact of an HRV-F training program on two adults with chronic SCI (T1 AIS A and T3 AIS C) with different degrees of remaining cardiac autonomic function. The HRV-F intervention involved 10 weeks of face-to-face and telehealth sessions with daily HRV-F home practice. Physiological (HRV, blood pressure variability (BPV), baroreflex sensitivity (BRS)), and self-reported assessments (Fatigue Severity Scale, Generalised Anxiety Disorder Scale, Patient Health Questionnaire, Appraisal of Disability and Participation Scale, EuroQol Visual Analogue Scale) were conducted at baseline and 10 weeks. Participants also completed weekly diaries capturing mood, anxiety, pain, sleep quality, fatigue, and adverse events. Results showed some improvement in HRV, BPV, and BRS. Additionally, participants self-reported some improvements in mood, fatigue, pain, quality of life, and self-perception. A 10-week HRV-F intervention was feasible in two participants with chronic SCI, warranting further investigation into its autonomic and psychosocial effects.
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Affiliation(s)
- Jacob Schoffl
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Mohit Arora
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Candice McBain
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Dianah Rodrigues
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Elham Vafa
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia;
| | - James Middleton
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Glen M. Davis
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia;
| | - Sylvia Maria Gustin
- NeuroRecovery Research Hub, University of New South Wales, Sydney, NSW 2052, Australia;
- The Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2052, Australia
| | - John Bourke
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Annette Kifley
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Andrei V. Krassioukov
- ICORD, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Ian D. Cameron
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
| | - Ashley Craig
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (M.A.); (I.P.); (C.M.); (D.R.); (E.V.); (J.M.); (J.B.); (A.K.); (I.D.C.); (A.C.)
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
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Wecht JM, Weir JP, Peters CG, Weber E, Wylie GR, Chiaravalloti NC. Autonomic Cardiovascular Control, Psychological Well-Being, and Cognitive Performance in People With Spinal Cord Injury. J Neurotrauma 2023; 40:2610-2620. [PMID: 37212256 DOI: 10.1089/neu.2022.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
PURPOSE To examine associations between parameters of psychological well-being, injury characteristics, cardiovascular autonomic nervous system (ANS) control, and cognitive performance in persons with spinal cord injury (SCI) compared with age-matched uninjured controls. This is an observational, cross-sectional study including a total of 94 participants (52 with SCI and 42 uninjured controls: UIC). Cardiovascular ANS responses were continuously monitored at rest and during administration of the Paced Auditory Serial Addition Test (PASAT). Self-report scores on the SCI-Quality of Life questionnaires are reported for depression, anxiety, fatigue, resilience, and positive affect. Participants with SCI performed significantly more poorly on the PASAT compared with the uninjured controls. Although not statistically significant, participants with SCI tended to report more psychological distress and less well-being than the uninjured controls. In addition, when compared with uninjured controls, the cardiovascular ANS responses to testing were significantly altered in participants with SCI; however, these responses to testing did not predict PASAT performance. Self-reported levels of anxiety were significantly related to PASAT score in the SCI group, but there was no significant relationship between PASAT and the other indices of SCI-Quality of Life. Future investigations should more closely examine the relationship among cardiovascular ANS impairments, psychological disorders, and cognitive dysfunction to better elucidate the underpinnings of these deficits and to guide interventions aimed at improving physiological, psychological, and cognitive health after SCI. Tetraplegia, paraplegia, blood pressure variability, cognitive, mood.
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Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, New York, USA
- Bronx Veterans Medical Research Foundation, Bronx, New York, USA
- Department of Medicine, the Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, the Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Science, University of Kansas, Lawrence, Kansas, USA
| | - Caitlyn G Peters
- James J Peters VA Medical Center, Bronx, New York, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Erica Weber
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Glenn R Wylie
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Nancy C Chiaravalloti
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
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Hockin BCD, Lucci VEM, Wu REY, Nicholas M, Parsons IT, Claydon VE. Pain associated with intravascular instrumentation reduces orthostatic tolerance and predisposes to vasovagal reactions in healthy young adults without needle phobia: a randomised controlled study. Clin Auton Res 2023; 33:673-689. [PMID: 37589875 DOI: 10.1007/s10286-023-00972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Vasovagal syncope (VVS), or fainting, is frequently triggered by pain, fear, or emotional distress, especially with blood-injection-injury stimuli. We aimed to examine the impact of intravenous (IV) instrumentation on orthostatic tolerance (OT; fainting susceptibility) in healthy young adults. We hypothesized that pain associated with IV procedures would reduce OT. METHODS In this randomised, double-blind, placebo-controlled, cross-over study, participants (N = 23; 14 women; age 24.2 ± 4.4 years) underwent head-up tilt with combined lower body negative pressure to presyncope on three separate days: (1) IV cannulation with local anaesthetic cream (EMLA) (IV + EMLA); (2) IV cannulation with placebo cream (IV + Placebo); (3) sham IV cannulation with local anaesthetic cream (Sham + EMLA). Participants rated pain associated with IV procedures on a 1-5 scale. Cardiovascular (finger plethysmography and electrocardiogram; Finometer Pro), and forearm vascular resistance (FVR; brachial Doppler) responses were recorded continuously and non-invasively. RESULTS Compared to Sham + EMLA (27.8 ± 2.4 min), OT was reduced in IV + Placebo (23.0 ± 2.8 min; p = 0.026), but not in IV + EMLA (26.2 ± 2.2 min; p = 0.185). Pain was increased in IV + Placebo (2.8 ± 0.2) compared to IV + EMLA (2.0 ± 2.2; p = 0.002) and Sham + EMLA (1.1 ± 0.1; p < 0.001). Orthostatic heart rate responses were lower in IV + Placebo (84.4 ± 3.1 bpm) than IV + EMLA (87.3 ± 3.1 bpm; p = 0.007) and Sham + EMLA (87.7 ± 3.1 bpm; p = 0.001). Maximal FVR responses were reduced in IV + Placebo (+ 140.7 ± 19.0%) compared to IV + EMLA (+ 221.2 ± 25.9%; p < 0.001) and Sham + EMLA (+ 190.6 ± 17.0%; p = 0.017). CONCLUSIONS Pain plays a key role in predisposing to VVS following venipuncture, and our data suggest this effect is mediated through reduced capacity to achieve maximal sympathetic activation during orthostatic stress. Topical anaesthetics, such as EMLA, may reduce the frequency and severity of VVS during procedures requiring needles and intravascular instrumentation.
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Affiliation(s)
- Brooke C D Hockin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Vera-Ellen M Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Ryan E Y Wu
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Michelle Nicholas
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Iain T Parsons
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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Schoffl J, Pozzato I, Rodrigues D, Arora M, Craig A. Pulse rate variability: An alternative to heart rate variability in adults with spinal cord injury. Psychophysiology 2023; 60:e14356. [PMID: 37287336 DOI: 10.1111/psyp.14356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/16/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
Pulse rate variability (PRV) is often used as an alternative to heart rate variability (HRV) to measure psychophysiological function. However, its validity to do so is unclear, especially in adults with spinal cord injury (SCI). This study compared PRV and HRV in adults with higher-level SCI (SCI-H, n = 23), lower-level SCI (SCI-L, n = 22), and able-bodied participants (AB n = 44), in a seated position as a function of performance in a reactivity task (Oxford Sleep Resistance Test: OSLER). PRV and HRV was measured using reflective finger-based photoplethysmography (PPG) and electrocardiography, respectively, at baseline, immediately post-OSLER, and after five-minute recovery. Agreement between PRV and HRV was determined by Bland-Altman analysis and differences between PRV and HRV over time by linear mixed effects model (LMM) analysis. Concurrent validity was assessed through correlation analyses between PRV and HRV. Additional correlation analyses were performed with psychosocial factors. Results indicated insufficient to moderate agreement between PRV and HRV. LMM analyses indicated no differences over time for standard deviation of normal-to-normal intervals and low-frequency power but significant differences for root mean square of successive differences and high frequency power. Nevertheless, PRV and HRV were highly correlated (Median r = .878 (.675-.990)) during all assessment periods suggesting sufficient concurrent validity. Similar correlation patterns were also found for PRV and HRV with psychosocial outcomes. While differences existed, results suggest PRV derived from reflective finger-based PPG is a valid proxy of HRV in tracking psychophysiological function in adults with SCI and could therefore be used as a more accessible monitoring tool.
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Affiliation(s)
- Jacob Schoffl
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ilaria Pozzato
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dianah Rodrigues
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Lucci VEM. Recent updates in autonomic research: advances in the understanding of autonomic dysfunction after spinal cord injury. Clin Auton Res 2023; 33:83-85. [PMID: 37071264 DOI: 10.1007/s10286-023-00944-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Vera-Ellen M Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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Williams EL, Hockin BCD, Heeney ND, Elabd K, Chong H, Blaber AP, Robinovitch SN, Parsons IT, Claydon VE. Exaggerated postural sway improves orthostatic cardiovascular and cerebrovascular control. Front Cardiovasc Med 2023; 10:1040036. [PMID: 36873416 PMCID: PMC9978805 DOI: 10.3389/fcvm.2023.1040036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Healthy individuals with poor cardiovascular control, but who do not experience syncope (fainting), adopt an innate strategy of increased leg movement in the form of postural sway that is thought to counter orthostatic (gravitational) stress on the cardiovascular system. However, the direct effect of sway on cardiovascular hemodynamics and cerebral perfusion is unknown. If sway produces meaningful cardiovascular responses, it could be exploited clinically to prevent an imminent faint. Methods Twenty healthy adults were instrumented with cardiovascular (finger plethysmography, echocardiography, electrocardiogram) and cerebrovascular (transcranial Doppler) monitoring. Following supine rest, participants performed a baseline stand (BL) on a force platform, followed by three trials of exaggerated sway (anterior-posterior, AP; mediolateral, ML; square, SQ) in a randomized order. Results All exaggerated postural sway conditions improved systolic arterial pressure (SAP, p = 0.001) responses, while blunting orthostatic reductions in stroke volume (SV, p < 0.01) and cerebral blood flow (CBFv, p < 0.05) compared to BL. Markers of sympathetic activation (power of low-frequency oscillations in SAP, p < 0.001) and maximum transvalvular flow velocity (p < 0.001) were reduced during exaggerated sway conditions. Responses were dose-dependent, with improvements in SAP (p < 0.001), SV (p < 0.001) and CBFv (p = 0.009) all positively correlated with total sway path length. Coherence between postural movements and SAP (p < 0.001), SV (p < 0.001) and CBFv (p = 0.003) also improved during exaggerated sway. Discussion Exaggerated sway improves cardiovascular and cerebrovascular control and may supplement cardiovascular reflex responses to orthostatic stress. This movement provides a simple means to boost orthostatic cardiovascular control for individuals with syncope, or those with occupations that require prolonged motionless standing.
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Affiliation(s)
- Erin L Williams
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Brooke C D Hockin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Natalie D Heeney
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Karam Elabd
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Helen Chong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrew P Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Iain T Parsons
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom.,School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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Solinsky R, Schleifer GD, Draghici AE, Hamner JW, Taylor JA. Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration. PM R 2022; 14:1483-1489. [PMID: 35077032 PMCID: PMC9309192 DOI: 10.1002/pmrj.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Heart rate variability is a measure of autonomic activity that is growing in popularity as a research outcome. However, despite its increased use, the known effects of respiration on heart rate variability measures are rarely accounted for in rehabilitation medicine research, leading to potential misinterpretation. OBJECTIVE To describe the effect that unpaced and paced breathing introduces to heart rate variability measures in a rehabilitation medicine relevant example of individuals with spinal cord injury. DESIGN Cross-sectional comparison of heart rate variability during unpaced and paced breathing (0.25 Hz, 15 breaths per minute) within the same individuals during the same lab session. SETTING Academic autonomic physiology laboratory. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mean low frequency (LF) and high frequency (HF) heart rate variability power, percentage of total power derived from the LF spectrum, LF:HF ratio. RESULTS Fifty-nine individuals with spinal cord injury completed laboratory assessments using standardized protocols (NCT02139436). In repeated measures within individuals, mean LF power was significantly higher in unpaced breathing compared to paced breathing (1292 vs. 573 ms2 , p < .001). A Bland-Altman plot demonstrated significant positive proportional bias for LF power when comparing unpaced and paced breathing conditions (R2 = 0.39). Mean HF power was similar between unpaced and paced breathing conditions, although there were wide positive and negative differences between measures, leading to notable uncertainty when respiratory confounders were not accounted for. The percentages of total power derived from the LF spectrum and the mean LF:HF ratio were both significantly higher for unpaced breathing compared to paced breathing (64 vs. 42%, p < .001; and 3.2 vs. 1.1, p < .001, respectively). CONCLUSION Respiration has a significant effect on heart rate variability following spinal cord injury, and not accounting for this has serious consequences for accurate interpretation of unpaced data. Future studies of heart rate variability in rehabilitation medicine should accordingly consider paced breathing.
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Affiliation(s)
- Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | | | - Adina E Draghici
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - Jason W Hamner
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - J Andrew Taylor
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
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9
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Wecht JM, Weir JP, Noonavath M, Vaccaro DH, Escalon MX, Huang V, Bryce TN. Evaluation of Cardiovascular Autonomic Function during Inpatient Rehabilitation following Traumatic Spinal Cord Injury. J Neurotrauma 2022; 39:1636-1644. [PMID: 35579968 PMCID: PMC9734019 DOI: 10.1089/neu.2021.0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Assessment of the degree of impaired autonomic nervous system (ANS) function is not part of routine clinical practice during inpatient rehabilitation following traumatic spinal cord injury (SCI). The goal of this investigation was to determine the utility of the International Standards for Neurologic Classification of SCI (ISNCSCI) and the recently revised International Standards to document remaining Autonomic Function after SCI (ISAFSCI) in documenting cardiovascular ANS impairment during inpatient rehabilitation following traumatic SCI. Beat-to-beat recording of supine heart rate (HR) and blood pressure (BP) were collected at the bedside for estimation of total cardiovascular ISAFSCI score, cardio-vagal modulation (i.e., high frequency HR variability [HFHRV]) and sympathetic vasomotor regulation (i.e., Mayer wave component of systolic BP [SBPmayer]). A total of 41 participants completed baseline testing, which was conducted 11 ± 5 days from the admission ISNCSCI examination. There were no differences in supine HR or BP based on the ISNCSCI or ISAFSCI assessments. The HFHRV was generally lower with more distal lesions (r2 = 0.15; p = 0.01), and SBPmayer was significantly lower in those with American Spinal Injury Association Impairment Scale (AIS) A compared with AIS B, C, D (Cohen's d = -1.4; p < 0.001). There were no significant differences in HFHRV or SBPmayer in patients with or without ISAFSCI evidence of cardiovascular ANS impairment. These preliminary data suggest that neither the ISNCSCI nor the ISAFSCI are sensitive to changes in ANS cardiovascular function following traumatic SCI. Bedside assessment of HR and BP variabilities may provide insight, but are not readily available in the clinical setting. Further research is required to evaluate methods that accurately assess the degree of ANS impairment following traumatic SCI.
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Affiliation(s)
- Jill M. Wecht
- James J. Peters VA Medical Center, Bronx, New York, USA
- Bronx Veterans Medical Research Foundation, Bronx, New York, USA
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Joseph P. Weir
- Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
| | - Meghana Noonavath
- James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Daniel H. Vaccaro
- James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Miguel X. Escalon
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Vincent Huang
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Thomas N. Bryce
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
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10
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Chen XY, Wang MH, Xiao X, Dong YH, Tan B, Dong HR, Zhou LN, Zhao JL, Xie R. Blood Pressure Variability Associates with Six-Month Outcomes in Acute Cervical Spinal Cord Injury: An Analysis of 105 Patients. World Neurosurg 2022; 168:e480-e489. [DOI: 10.1016/j.wneu.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
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11
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Sahota IS, Lucci VEM, McGrath MS, Ravensbergen HJC(R, Claydon VE. Cardiovascular and cerebrovascular responses to urodynamics testing after spinal cord injury: The influence of autonomic injury. Front Physiol 2022; 13:977772. [PMID: 36187786 PMCID: PMC9525190 DOI: 10.3389/fphys.2022.977772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Autonomic dysfunction is a prominent concern following spinal cord injury (SCI). In particular, autonomic dysreflexia (AD; paroxysmal hypertension and concurrent bradycardia in response to sensory stimuli below the level of injury) is common in autonomically-complete injuries at or above T6. AD is currently defined as a >20 mmHg increase in systolic arterial pressure (SAP) from baseline, without heart rate (HR) criteria. Urodynamics testing (UDS) is performed routinely after SCI to monitor urological sequelae, often provoking AD. We, therefore, aimed to assess the cardiovascular and cerebrovascular responses to UDS and their association with autonomic injury in individuals with chronic (>1 year) SCI. Following blood draw (plasma norepinephrine [NE]), continuous SAP, HR, and middle cerebral artery blood flow velocity (MCAv) were recorded at baseline (10-minute supine), during standard clinical UDS, and recovery (10-minute supine) (n = 22, age 41.1 ± 2 years, 15 male). Low frequency variability in systolic arterial pressure (LF SAP; a marker of sympathetic modulation of blood pressure) and cerebral resistance were determined. High-level injury (≥T6) with blunted/absent LF SAP (<1.0 mmHg2) and/or low plasma NE (<0.56 nmol•L−1) indicated autonomically-complete injury. Known electrocardiographic markers of atrial (p-wave duration variability) and ventricular arrhythmia (T-peak–T-end variability) were evaluated at baseline and during UDS. Nine participants were determined as autonomically-complete, yet 20 participants had increased SAP >20 mmHg during UDS. Qualitative autonomic assessment did not discriminate autonomic injury. Maximum SAP was higher in autonomically-complete injuries (207.1 ± 2.3 mmHg) than autonomically-incomplete injuries (165.9 ± 5.3 mmHg) during UDS (p < 0.001). HR during UDS was reduced compared to baseline (p = 0.056) and recovery (p = 0.048) only in autonomically-complete lesions. MCAv was not different between groups or phases (all p > 0.05). Cerebrovascular resistance index was increased during UDS in autonomically-complete injuries compared to baseline (p < 0.001) and recovery (p < 0.001) reflecting intact cerebral autoregulation. Risk for both atrial and ventricular arrhythmia increased during UDS compared to baseline (p < 0.05), particularly in autonomically-complete injuries (p < 0.05). UDS is recommended yearly in chronic SCI but is associated with profound AD and an increased risk of arrhythmia, highlighting the need for continued monitoring during UDS. Our data also highlight the need for HR criteria in the definition of AD and the need for quantitative consideration of autonomic function after SCI.
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Affiliation(s)
- Inderjeet S. Sahota
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Vera-Ellen M. Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Maureen S. McGrath
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - H. J. C. (Rianne) Ravensbergen
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Victoria E. Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Victoria E. Claydon,
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12
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Raguindin PF, Stoyanov J, Eriks-Hoogland I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from Swiss Spinal Cord Injury cohort (SwiSCI). PM R 2022. [PMID: 35648677 DOI: 10.1002/pmrj.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early screening is important in individuals with spinal cord injury (SCI) as they were deemed high-risk for cardiometabolic diseases. Few studies explored changes in cardiometabolic risk profile in the early phase of the injury. Thus, it remains unclear how early the cardiometabolic status deteriorates after injury. OBJECTIVE We determined the longitudinal changes in the cardiometabolic risk profile and examined the association between injury characteristics and cardiometabolic status in subacute SCI. SETTING Multicenter Swiss Spinal Cord Injury Cohort. PARTICIPANTS Adults with traumatic SCI without history of cardiovascular disease or type 2 diabetes. MAIN OUTCOME MEASURES Blood pressure (BP), lipid profile, fasting glucose, waist circumference (WC), weight, body mass index (BMI) and Framingham risk score (FRS) were compared across time and according to the injury characteristics. RESULTS We analyzed the data of 258 individuals with traumatic SCI (110 tetraplegia and 148 paraplegia, 122 motor complete and 136 incomplete). The median age was 50 years (IQR 32-60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2-7.1). At admission to rehabilitation, fully-adjusted linear regression models showed higher baseline weight (β 0.06, 95% CI 0.005, 0.11), systolic BP (β 0.05, 95% CI 0.008, 0.09), diastolic BP (β 0.05 95% CI 0.004, 0.10), and triglycerides (β 0.27 95% CI 0.13, 0.42) in paraplegia than tetraplegia. Systolic BP, diastolic BP, HDL-C were higher in incomplete than complete injury. In our main analysis, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation. Individuals with paraplegia had a higher increase in BMI than tetraplegia, while no differences in other cardiometabolic risk factors were detected when comparing motor incomplete and complete injury. Trajectories of each participant showed that the majority of individuals with SCI decreased FRS score at follow-up compared to baseline and no significant changes in prevalence of cardiometabolic syndrome were observed. At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had cardiometabolic syndrome. CONCLUSION We observed a modest improvement in lipid profile and FRS during the first inpatient rehabilitation hospitalization. Injury characteristics, such as level and completeness, were not associated with changes in cardiometabolic risk factors in the subacute phase of the injury. Despite this, a significant proportion of study participants remained at risk of cardiometabolic disease at discharge, suggesting that early cardiometabolic preventive strategies may be initiated as early as during the first inpatient rehabilitation hospitalization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Xavier Jordan
- Clinique Romande de Réadaptation, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Martin Schubert
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse 340, Zurich, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
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13
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Parsons IT, Hockin BCD, Taha OM, Heeney ND, Williams EL, Lucci VEM, Lee RHY, Stacey MJ, Gall N, Chowienczyk P, Woods DR, Claydon VE. The effect of water temperature on orthostatic tolerance: a randomised crossover trial. Clin Auton Res 2022; 32:131-141. [PMID: 35461434 PMCID: PMC9064858 DOI: 10.1007/s10286-022-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
Purpose Bolus water drinking, at room temperature, has been shown to improve orthostatic tolerance (OT), probably via sympathetic activation; however, it is not clear whether the temperature of the water bolus modifies the effect on OT or the cardiovascular responses to orthostatic stress. The aim of this study was to assess whether differing water temperature of the water bolus would alter time to presyncope and/or cardiovascular parameters during incremental orthostatic stress. Methods Fourteen participants underwent three head-up tilt (HUT) tests with graded lower body negative pressure (LBNP) continued until presyncope. Fifteen minutes prior to each HUT, participants drank a 500 mL bolus of water which was randomised, in single-blind crossover fashion, to either room temperature water (20 °C) (ROOM), ice-cold water (0–3 °C) (COLD) or warm water (45 °C) (WARM). Cardiovascular parameters were monitored continuously. Results There was no significant difference in OT in the COLD (33 ± 3 min; p = 0.3321) and WARM (32 ± 3 min; p = 0.6764) conditions in comparison to the ROOM condition (31 ± 3 min). During the HUT tests, heart rate and cardiac output were significantly reduced (p < 0.0073), with significantly increased systolic blood pressure, stroke volume, cerebral blood flow velocity and total peripheral resistance (p < 0.0054), in the COLD compared to ROOM conditions. Conclusions In healthy controls, bolus cold water drinking results in favourable orthostatic cardiovascular responses during HUT/LBNP without significantly altering OT. Using a cold water bolus may result in additional benefits in patients with orthostatic intolerance above those conferred by bolus water at room temperature (by ameliorating orthostatic tachycardia and enhancing vascular resistance responses). Further research in patients with orthostatic intolerance is warranted.
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14
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Leveraging Continuous Vital Sign Measurements for Real-Time Assessment of Autonomic Nervous System Dysfunction After Brain Injury: A Narrative Review of Current and Future Applications. Neurocrit Care 2022; 37:206-219. [PMID: 35411542 DOI: 10.1007/s12028-022-01491-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
Subtle and profound changes in autonomic nervous system (ANS) function affecting sympathetic and parasympathetic homeostasis occur as a result of critical illness. Changes in ANS function are particularly salient in neurocritical illness, when direct structural and functional perturbations to autonomic network pathways occur and may herald impending clinical deterioration or intervenable evolving mechanisms of secondary injury. Sympathetic and parasympathetic balance can be measured quantitatively at the bedside using multiple methods, most readily by extracting data from electrocardiographic or photoplethysmography waveforms. Work from our group and others has demonstrated that data-analytic techniques can identify quantitative physiologic changes that precede clinical detection of meaningful events, and therefore may provide an important window for time-sensitive therapies. Here, we review data-analytic approaches to measuring ANS dysfunction from routine bedside physiologic data streams and integrating this data into multimodal machine learning-based model development to better understand phenotypical expression of pathophysiologic mechanisms and perhaps even serve as early detection signals. Attention will be given to examples from our work in acute traumatic brain injury on detection and monitoring of paroxysmal sympathetic hyperactivity and prediction of neurologic deterioration, and in large hemispheric infarction on prediction of malignant cerebral edema. We also discuss future clinical applications and data-analytic challenges and future directions.
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15
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Orthostatic systemic and cerebral hemodynamics in newly injured patients with spinal cord injury. Auton Neurosci 2022; 240:102973. [DOI: 10.1016/j.autneu.2022.102973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
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Syed MUS, Khan Z, Zulfiqar A, Basham MA, Abdul Haseeb H, Azizullah S, Ismail H, Elbahnasawy M, Nadeem Z, Karimi S. Electrocardiographic Abnormalities in Patients With Spinal Cord Injury With Deranged Lipid Profile. Cureus 2021; 13:e18246. [PMID: 34722039 PMCID: PMC8544921 DOI: 10.7759/cureus.18246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Spinal cord injury (SCI) can lead to severe disability and neurogenic shock, arrhythmias, autonomic dysfunction, pressure ulcers, etc., of the autonomic nervous system. Therefore, in these patients, cardiovascular problems should be investigated frequently. This study was conducted to evaluate the electrocardiographic (ECG) abnormalities in patients with spinal cord injury having inappropriate lipid profiles and their relationship with each other. Materials and methods This cross-sectional study was held in the Internal Medicine Department of Mayo Hospital, Lahore, for a one-year duration from May 2020 to May 2021. It included 58 patients with spinal cord injury, 35 of whom had paraplegia, and 23 had tetraplegia. Fasting blood samples were taken for lipid profile analysis. Twelve-lead ECGs three times a day for one month were taken and analyzed in the context of previously available ECGs. Results Out of 58, the lipid profiles were found abnormal in 47 patients, 18 of whom had a normal ECG. The lipid profile was normal in 12, of which only one patient had ECG abnormalities. Cholesterol levels were found normal in 39 patients and deranged in 19 patients; low-density lipoproteins in nine patients, triglycerides in 18 patients, and high-density lipoprotein values in one patient were abnormal. Conclusions Sinus bradycardia was the most common ECG abnormality found in SCI patients with deranged lipid profiles. Further studies are needed in the future to validate the findings of this study.
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Affiliation(s)
| | - Zunaira Khan
- Accident and Emergency, Kingston Hospital, London, GBR
| | - Arif Zulfiqar
- Internal Medicine, Dow Medical College, Karachi, PAK
| | | | | | - Saad Azizullah
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hebatalla Ismail
- Medicine and Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Mohammad Elbahnasawy
- Internal Medicine, Alexandria Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Zubia Nadeem
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sundas Karimi
- Orthopedic Surgery, Dow University of Health Sciences, Karachi, PAK
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17
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Wang S, Wecht JM, Legg Ditterline B, Ugiliweneza B, Maher MT, Lombard AT, Aslan SC, Ovechkin AV, Bethke B, Gunter JTH, Harkema SJ. Heart rate and blood pressure response improve the prediction of orthostatic cardiovascular dysregulation in persons with chronic spinal cord injury. Physiol Rep 2020; 8:e14617. [PMID: 33080121 PMCID: PMC7575221 DOI: 10.14814/phy2.14617] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
Unstable blood pressure after spinal cord injury (SCI) is not routinely examined but rather predicted by level and completeness of injury (i.e., American Spinal Injury Association Impairment Scale AIS classification). Our aim was to investigate hemodynamic response to a sit-up test in a large cohort of individuals with chronic SCI to better understand cardiovascular function in this population. Continuous blood pressure and ECG were recorded from individuals with SCI (n = 159) and non-injured individuals (n = 48). We found orthostatic hypotension occurred within each level and AIS classification (n = 36). Moreover, 45 individuals with chronic SCI experienced a drop in blood pressure that did not meet the criteria for orthostatic hypotension, but was accompanied by dramatic increases in heart rate, reflecting orthostatic intolerance. A cluster analysis of hemodynamic response to a seated position identified eight distinct patterns of interaction between blood pressure and heart rate during orthostatic stress indicating varied autonomic responses. Algorithmic cluster analysis of heart rate and blood pressure is more sensitive to diagnosing orthostatic cardiovascular dysregulation. This indicates blood pressure instability cannot be predicted by level and completeness of SCI, and the consensus statement definition of orthostatic hypotension is insufficient to characterize the variability of blood pressure and heart rate responses during orthostatic stress. Both blood pressure and heart rate responses are needed to characterize autonomic function after SCI.
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Affiliation(s)
- Siqi Wang
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Jill M. Wecht
- James J Peters VA Medical CenterBronxNYUSA
- Departments of Medicine and Rehabilitation Medicinethe Icahn School of MedicineMount SinaiNew YorkNYUSA
| | - Bonnie Legg Ditterline
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Matthew T. Maher
- James J Peters VA Medical CenterBronxNYUSA
- Kessler Institute for RehabilitationWest OrangeNJUSA
| | - Alexander T. Lombard
- James J Peters VA Medical CenterBronxNYUSA
- Kessler Institute for RehabilitationWest OrangeNJUSA
| | - Sevda C. Aslan
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Alexander V. Ovechkin
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
| | | | | | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleKYUSA
- Frazier Rehab InstituteLouisvilleKYUSA
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