Altered left ventricular diastolic function in subjects with spinal cord injury

Matos‐Souza, José R.; Pithon, Karla Rocha; Oliveira, Rômulo Tadeu Dias de; Téo, Fábio Haach; Blotta, Maria Heloı́sa Souza Lima; Cliquet, Alberto; Nadruz, Wilson

doi:10.1038/sc.2010.88

Cited by 33 publications

(29 citation statements)

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“…The diastolic function, as assessed by E, A and E/A ratio, was not significantly impaired in our SCI individuals. These data are consistent with those obtained by Eysmann et al 19 by conventional echocardiography, whereas more recently Matos-Sousa et al 4 demonstrated a lower early diastolic filling in a group of paraplegics compared with ABL subjects. Interestingly, we reported a higher IVRT in our SCI individuals, which may suggest some difficulties in the very early diastolic filling.…”

Section: Discussionsupporting

confidence: 82%

“…However, as recently proposed by Matos-Souza et al, 4 this may suggest that the chronically reduced venous return may have been compensated by a subsequent activation of the hormonal regulatory system, such as the renin-angiotensin-aldosterone system, in order to maintain blood pressure. This, in turn, may have stimulated LV remodeling, increasing LV wall thickness.…”

Section: Discussionmentioning

confidence: 56%

“…2 A previous study demonstrated a reduction in LV mass and dimension in tetraplegic subjects, 3 and a more recent study showed an altered LV diastolic function and a subclinical decrease in systolic function in spinal cord injury (SCI) individuals. 4 In these patients, the reduced venous return due to the loss of sublesional vascular sympathetic innervation and of the muscular pump may cause a reduced adaptation of stroke volume to exercise, 5 which needs to be compensated by a higher submaximal heart rate, compared with that observed in ABL subjects. 6,7 Indeed, Dela et al 5 demonstrated a stroke volume increase of about +35% in paraplegics compared with a +50% increase in ABL people during a steady-state moderate exercise.…”

Section: Introductionmentioning

confidence: 99%

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Heart adaptations to long-term aerobic training in paraplegic subjects: an echocardiographic study

et al. 2012

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Study design: Case-control. Objectives: To execute an echocardiographic comparison between trained and untrained spinal cord injury (SCI) subjects, and to evaluate whether long-term heart adjustments to endurance training are comparable to those observed in able-bodied (ABL) subjects. Setting: Italy. Methods: We enrolled: (1) 17 male SCI patients (lesion level T 1 -L 3 , 34±8 years, body mass index (BMI) 23.0±2.8 kg m À2 ), 10 of whom were aerobically trained for 45 years (SCI T ); (2) 18 age-, sex-and BMI-matched ABL subjects (35 ± 6 years, BMI 23.6 ± 2.8 kg m À2 ), 10 of whom were aerobically trained for 45 years (ABL T ). Training frequency and volume were recorded by a dedicated questionnaire. All subjects underwent a trans-thoracic echocardiography; SCI subjects also performed an exhaustive incremental exercise test. Comparisons were made between ABL and SCI groups, between trained and untrained subjects within each group (analysis of variance). Results: Effects of SCI-Compared with ABL subjects, SCI patients showed lower end-diastolic volume (76±21 vs 113±23 ml, Po0.05) and ejection fraction (61±7% vs 65±5%, Po0.05). Effects of training-Compared with untrained status, the intra-ventricular septum thickness (SCI, +18%; ABL, +4%), the posterior wall thickness (SCI, +17%; ABL, +2%) and the total normalized heart mass (SCI, +48%; ABL, +5%) were higher in both SCI T and in ABL T . VO 2 peak was higher in the SCI T subgroup compared with the SCI U group. Conclusions: Heart seems to positively adapt to long-term endurance training in SCI patients. Regular exercise may therefore increase heart size, septum and posterior wall thickness, which likely contributes to improved VO 2 peak. These morphological and functional changes may reduce cardiovascular risk in SCI individuals. INTRODUCTIONThe positive effects of endurance training on heart morphology and function are well acknowledged in able-bodied (ABL) individuals: besides the typical development of bradycardia and the improvement in coronary perfusion, cardiac morphology usually shifts toward a physiological left ventricular (LV) hypertrophy with increased mass and internal volume of the left ventricle, and improved systolic and diastolic functions (for a review, see Pavlik et al. 1 ). In ABL endurance-trained individuals, the increased stroke volume finally yields an augmented cardiac output during exercise compared with untrained subjects. 2 A previous study demonstrated a reduction in LV mass and dimension in tetraplegic subjects, 3 and a more recent study showed an altered LV diastolic function and a subclinical decrease in systolic function in spinal cord injury (SCI) individuals. 4 In these patients, the reduced venous return due to the loss of sublesional vascular sympathetic innervation and of the muscular pump may cause a reduced adaptation of stroke volume to exercise, 5 which needs to be compensated by a higher submaximal heart rate, compared with that observed in ABL subjects. 6,7 Indeed, Dela et al. 5 demonstrated a stroke volume increase of about ...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

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Heart adaptations to long-term aerobic training in paraplegic subjects: an echocardiographic study

et al. 2012

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“…We think chronic exposure to episodic hypertension because of AD may contribute to cardiac dysfunction after SCI because both clinical and preclinical studies reveal major similarities in the cardiac phenotype that develops in both hypertensive heart disease and SCI. [25][26][27][28][29][30][31][32][33] As such, the episodic hypertension commonly experienced in people with SCI during frequent bouts of AD may provide a potential explanation for the increased risk of heart disease in this population. Moreover, understanding how AD affects cardiac function in SCI may provide novel insight into the cardiac consequences of other conditions that are characterized by paroxysmal hypertension, such as preeclampsia or gestational hypertension, 34 as well as providing information on the relative hypertensive stimulus required for hypertensive heart disease.…”

Section: Hypertensionmentioning

confidence: 99%

Cardiac Consequences of Autonomic Dysreflexia in Spinal Cord Injury

et al. 2016

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Abstract-Autonomic dysreflexia (AD), which describes episodic hypertension, is highly prevalent in people with spinal cord injury (SCI). In non-SCI, primary hypertension depresses cardiac contractile reserve via β-adrenergic mechanisms.In this study, we investigated whether AD contributes to the impairment in cardiac contractile function that accompanies SCI. We induced SCI in rodents and stratified them into sham, SCI, or SCI plus repetitive induction of AD. At 6-week post-SCI, we assessed cardiac function using in vivo (speckle-tracking echocardiography), ex vivo (working heart), and molecular approaches (Western blot). We also provide unique translational insight by comparing the relationship between the number of daily AD events and cardiac function in 14 individuals with cervical SCI. We found SCI and SCI plus repetitive induction of AD exhibited a reduction in left ventricular dimensions at 6-week post-SCI versus preinjury (P<0.049). Compared with sham, SCI exhibited a reduction in peak radial strain along with a down and rightward shift in the Starling curve (P<0.037), both of which were further depressed in SCI plus repetitive induction of AD (P<0.042). In response to β-adrenergic stimulation, SCI plus repetitive induction of AD exhibited an attenuated increase in contractile indices (P<0.001), despite no differences in β-receptor expression within the left ventricle. Our clinical data confirm our experimental findings by demonstrating significant associations between the number of daily AD events and markers of systolic and diastolic function along with left ventricular mechanics. Here, we provide the first evidence from a translational perspective that AD exerts insidious effects on cardiac function in rodents and humans with SCI.

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Ambulatory blood pressure is associated with subclinical atherosclerosis in spinal cord injury subjects

Seabra-Garcez

Matos‐Souza

Goulart

et al. 2012

International Journal of Cardiology

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Subjects with chronic spinal cord injury (SCI) exhibit increased subclinical atherosclerosis and worse left ventricular diastolic function in comparison to able-bodied individuals, independent of traditional cardiovascular risk factors [1][2][3][4]. SCI may impair the descending spinal sympathetic tract and promote alterations in blood pressure (BP) profile, such as loss of nocturnal dipping due to orthostatic hypotension, and labile hypertension secondary to uncontrolled sympathetic output as a consequence of autonomic dysreflexia [5]. These alterations, in turn, could potentially explain the increased cardiovascular risk attributed to chronic SCI [5,6]. This study evaluated the relationship between carotid and echocardiographic features and Ambulatory BP monitoring (ABPM) in SCI patients.Thirty-two nondiabetic, nonhypertensive, nonsmoker, normotensive and normolipemic men attended at a university hospital outpatient clinic with at least 1 year of SCI were evaluated. SCI level ranged from C4 to T12 and only individuals without any preserved motor function below the injury level were included. Fasting serum glucose, lipids and Creactive protein were measured using standard laboratory techniques. Office blood pressure was measured in the sitting position using validated digital oscillometric device (Omron HEM-705CP, Omron Corp.). ABPM was carried out using a Spacelabs 90207 device. Nocturnal dipping was defined as a reduction in the average systolic and diastolic BP at night greater than 10% compared to daytime values. Carotid ultrasonography and echocardiography studies were performed on each subject in the sitting position with a Vivid 3 Pro apparatus as previously described [2,3]. The study was approved by the Ethics Committee of the State University of Campinas and informed consent was obtained from all participants. The authors certify that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [7]. All values were expressed as mean± standard error and median (interquartile range). Univariate and linear regression analyses were used to evaluate the association between cardiovascular parameters and studied variables. A p-value b0.05 was considered significant.The features of enrolled subjects are shown in Table 1. No subject exhibited plaques at carotid ultrasound or presented complaints of autonomic dysreflexia or BP peaks at ABPM. ABPM values correlated with carotid IMT but not with cardiac parameters. In this regard, 24-h diastolic BP was the measurement showing major correlation with IMT (r =0.54; p =0.002) (Fig. 1). Conversely, office BP, nocturnal dipping status, clinical and laboratory variables exhibited no significant relationship with carotid or cardiac measurements. At last, linear regression analysis revealed that 24-h diastolic BP was the only variable independently associated with carotid IMT (β = 0.417 ± 0.193; p = 0.018) after adjustment for injury level (tetraplegia or paraplegia) and nocturnal dipping status.This report provided novel knowledge regard...

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Altered left ventricular diastolic function in subjects with spinal cord injury

Cited by 33 publications

References 20 publications

Heart adaptations to long-term aerobic training in paraplegic subjects: an echocardiographic study

Heart adaptations to long-term aerobic training in paraplegic subjects: an echocardiographic study

Cardiac Consequences of Autonomic Dysreflexia in Spinal Cord Injury

Ambulatory blood pressure is associated with subclinical atherosclerosis in spinal cord injury subjects

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