Longitudinal Assessment of Autonomic Function during the Acute Phase of Spinal Cord Injury: Use of Low-Frequency Blood Pressure Variability as a Quantitative Measure of Autonomic Function

Lucci, Vera-Ellen M; Inskip, Jessica A.; McGrath, Maureen S; Ruiz, Ian A.; Lee, Rebekah; Claydon, Victoria E.

doi:10.1089/neu.2020.7286

Cited by 17 publications

(21 citation statements)

References 48 publications

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“…Autonomic dysfunction is widespread following spinal cord injury (SCI) and profoundly impacts morbidity and mortality (Garshick et al, 2005). Injury to descending spinal autonomic pathways impairs sympathetic control of the heart and the vasculature, with the degree of impairment dependent on both the level and severity of spinal injury (Claydon and Krassioukov, 2007;Lucci et al, 2021a). Of particular concern, individuals with high-level SCI (injuries at or above the sixth thoracic spinal level [T6]) are at risk for a unique form of cardiovascular dysfunction known as autonomic dysreflexia (AD; paroxysmal hypertension in response to sensory stimuli, particularly visceral stimuli, below the level of spinal injury that persists until removal of the stimulus) (Blackmer, 2003;Krassioukov and Claydon, 2006;Llewellyn-Smith, Weaver and Keast, 2006).…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular and cerebrovascular responses to urodynamics testing after spinal cord injury: The influence of autonomic injury

et al. 2022

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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 mmHg 2 ) 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-Tend 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)

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Section: Introductionmentioning

confidence: 99%

Cardiovascular and cerebrovascular responses to urodynamics testing after spinal cord injury: The influence of autonomic injury

et al. 2022

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“…In addition, local sympathetic veno-arteriolar reflexes may contribute to the maintenance of orthostatic blood pressure, and these reflexes are mediated independently of supraspinal control (Henriksen, 1977;Henriksen & Sejrsen, 1977). AIS classification does not accurately predict the incidence of orthostatic hypotension after SCI, and previous studies demonstrate other predictors (e.g., sympathetic skin response) correlate with cardiovascular dysregulation better than motor-sensory completeness of injury (Claydon & Krassioukov, 2006;Lucci et al, 2020;Sahota et al, 2012).…”

Section: Prevalence Of Orthostatic Hypotension By Level and Severitmentioning

confidence: 98%

Heart rate and blood pressure response improve the prediction of orthostatic cardiovascular dysregulation in persons with chronic spinal cord injury

et al. 2020

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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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“…Spinal cord injury (SCI) is a catastrophic, unfortunate, and final event that impairs a person's motor, sensory, and autonomic functions throughout his life [ 1 , 2 ]. Spinal cord injury causes severe disability, and these patients experience secondary complications such as neurogenic shock, arrhythmias, autonomic dysfunction, pressure ulcers, bowel and bladder dysfunction, chronic pain, anxiety, and urinary tract infections [ 3 ]. These patients are at greater risk of cardiovascular complications due to impaired mobility and impairment of the autonomic nervous system [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Spinal cord injury causes severe disability, and these patients experience secondary complications such as neurogenic shock, arrhythmias, autonomic dysfunction, pressure ulcers, bowel and bladder dysfunction, chronic pain, anxiety, and urinary tract infections [ 3 ]. These patients are at greater risk of cardiovascular complications due to impaired mobility and impairment of the autonomic nervous system [ 3 ]. Often the most attention is paid to acute complications in their management, underestimating the chronic cardiovascular complications which are the leading cause of death and disease in patients with spinal cord injuries [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…These patients are at greater risk of cardiovascular complications due to impaired mobility and impairment of the autonomic nervous system [ 3 ]. Often the most attention is paid to acute complications in their management, underestimating the chronic cardiovascular complications which are the leading cause of death and disease in patients with spinal cord injuries [ 3 ]. The electrocardiogram (ECG) is a suitable, accurate, and highly effective tool for the early diagnosis or detection of these problems.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal Assessment of Autonomic Function during the Acute Phase of Spinal Cord Injury: Use of Low-Frequency Blood Pressure Variability as a Quantitative Measure of Autonomic Function

Cited by 17 publications

References 48 publications

Cardiovascular and cerebrovascular responses to urodynamics testing after spinal cord injury: The influence of autonomic injury

Cardiovascular and cerebrovascular responses to urodynamics testing after spinal cord injury: The influence of autonomic injury

Heart rate and blood pressure response improve the prediction of orthostatic cardiovascular dysregulation in persons with chronic spinal cord injury

Electrocardiographic Abnormalities in Patients With Spinal Cord Injury With Deranged Lipid Profile

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