Left ventricular mass and diastolic filling patterns in quadriplegia and implications for effects of normal aging on the heart

Eysmann, Susan B.; Douglas, Pamela S.; Katz, Sidney; Sarkarati, Mehdi; Wei, Jeanne Y.

doi:10.1016/s0002-9149(00)80082-x

Cited by 28 publications

(23 citation statements)

References 21 publications

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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: 91%

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: 91%

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

et al. 2012

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“…2 Previous studies in the literature aimed to evaluate LV diastolic function in subjects with SCI. Eysmann et al, 13 for instance, reported similar diastolic parameters in 17 subjects with SCI and in 17 able-bodied individuals, who were evaluated by conventional echocardiography. Conversely, de Groot et al 14 studied a smaller sample (seven tetraplegics and seven able-bodied subjects) and found no differences in LV diastolic function, as assessed by conventional echocardiography and tissue Doppler imaging.…”

Section: Discussionmentioning

confidence: 87%

Altered left ventricular diastolic function in subjects with spinal cord injury

et al. 2010

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Study design: This is cross-sectional study. Objectives: The aim of this study is to investigate the cardiac structure and function of subjects with spinal cord injury (SCI) and the impact of metabolic, hemodynamic and inflammatory factors on these parameters. Setting: São Paulo, Brazil. Methods: Sixty-five nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI and 31 healthy subjects) were evaluated by medical history, anthropometry, laboratory tests, analysis of hemodynamic and inflammatory parameters and echocardiography. Results: Subjects with SCI had lower systolic blood pressure and higher levels of C-reactive protein and tumor necrosis factor receptors than the healthy ones. Echocardiography data showed that the SCI group presented similar left ventricular (LV) structural and systolic parameters, but lower initial diastolic velocity (Em) (9.2 ± 0.5 vs 12.3 ± 0.5 cm s À1 ; Po0.001) and higher peak early inflow velocity (E)/Em ratio (7.7±0.5 vs 6.1±0.3; P ¼ 0.009) compared with the able-bodied group, even after adjustment for systolic blood pressure and C-reactive protein levels. Furthermore, injured subjects with E/Em 48 had lower peak spectral longitudinal contraction (Sm) (9.0±0.7 vs 11.6±0.4 cm s À1 ; Po0.001) and cardiac output (4.2 ± 0.2 vs 5.0 ± 0.2 l min À1 ; P ¼ 0.029), as well as higher relative wall thickness (0.38±0.01 vs 0.35±0.01; P ¼ 0.005), than individuals with SCI with E/Emo8, but similar age, body mass index, blood pressure, injury level, metabolic parameters and inflammatory marker levels. Conclusion: Subjects with SCI presented impaired LV diastolic function in comparison with ablebodied ones. Moreover, worse LV diastolic function was associated with a pattern of LV concentric remodeling and subclinical decreases in systolic function among injured subjects. Overall, these findings might contribute to explain the increased cardiovascular risk reported for individuals with SCI.

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“…21 The low resting BP is also consistent with the reduced left ventricular size noted in tetraplegic patients. 22 And although night-time, recumbent BPs were similar to those of paraplegia, this was only because the paraplegic BP diminished with sleep and the tetraplegic pressure did not. (The typical tetraplegic patient sleeps with his head elevated so that average night-time BP recordings may be spuriously low.…”

Section: Discussionmentioning

confidence: 97%