Pulse Wave Velocity for Assessment of Arterial Stiffness Among People With Spinal Cord Injury: A Pilot Study

Miyatani, Masae; Masani, Kei; Oh, Paul; Miyachi, Motohiko; Popović, Miloš R.; Craven, B. Catharine

doi:10.1080/10790268.2009.11760755

Cited by 60 publications

(54 citation statements)

References 40 publications

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“…56 Further to the adaptations that occur in the first 6 weeks after injury, there is evidence to suggest that chronic stiffening of the arterial system also occurs after SCI. 57,58 This is particularly worrying given that arterial stiffening is a significant independent risk factor for the development of CVD in the AB population. 59 Functional adaptations Shear stress.…”

Section: Conduit Arterial Function After Sci Structural Adaptationsmentioning

confidence: 99%

Peripheral vascular function in spinal cord injury: a systematic review

et al. 2012

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Background: During the past 20 years, significant advances in patient care have resulted in individuals with spinal cord injury (SCI) living longer than before. As lifespan increases, cardiovascular complications are emerging as the leading cause of mortality in this population, and individuals with SCI develop cardiovascular disease at younger ages than their able-bodied counterparts. To address this increasing clinical challenge, several recent studies investigated the central cardiovascular adaptations that occur following SCI. However, a somewhat less recognized component of cardiovascular dysfunction in this population is the peripheral vascular adaptations that also occur as a result of SCI. Study design: Literature review.Objective: To present a comprehensive overview of changes in arterial structure and function, which occur after SCI. Setting: Canada. Methods: A systematic literature review was conducted to extract studies that incorporated measures of arterial structure or function after SCI in animals or humans. Results: Individuals with SCI exhibit vascular dysfunction below the lesion that is characterized by a reduction in conduit artery diameter and blood flow, increased shear rate and leg vascular resistance, and adrenoceptor hyper-responsiveness. There is also recent alarming evidence for central arterial stiffening in individuals with SCI. Conclusion: Although physical deconditioning is the primary candidate responsible for the maladaptive remodeling of the peripheral vasculature after SCI, there is emerging evidence that blood pressure oscillations, such as those occurring in the large majority of individuals with SCI, also exacerbates vascular dysfunction in this population.

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Section: Conduit Arterial Function After Sci Structural Adaptationsmentioning

confidence: 99%

Peripheral vascular function in spinal cord injury: a systematic review

et al. 2012

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“…13,14,21 Elevated artery stiffness assessed using aPWV is associated with a 68% increased risk of CVD events and mortality in able-bodied subjects. 7 The present study demonstrated almost perfect reliability (ICC X0.81) 18 of applanation tonometry assessments of aPWV in SCI individuals, and therefore provides support for the continued use of this technique in the SCI population.…”

Section: Discussionmentioning

confidence: 99%

“…The first examination by Miyatani et al 13 demonstrated significantly higher aPWV in individuals with chronic SCI compared with age, sex, height and weight-matched able-bodied individuals. Using the equation used in our investigation, the average aPWV for their middle-aged sample (46±8 years) was 10.2 m s À1 .…”

Section: Discussionmentioning

confidence: 99%

“…To date, only Doppler ultrasound assessments of aPWV have been shown to be reliable in SCI individuals, 12 despite the fact that applanation tonometry has been identified by an expert panel as a well-accepted technique for the measurement of aPWV. 6 In addition, there are only a limited number of investigations that have addressed aPWV in SCI individuals, 13,14 despite its prognostic importance in the able-bodied population. In order to advance the research in this field, the feasibility of alternative aPWV measurement techniques in SCI needs to be established.…”

Section: Introductionmentioning

confidence: 99%

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Applanation tonometry: a reliable technique to assess aortic pulse wave velocity in spinal cord injury

2014

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Study design: Within-subject repeated measures. Objectives: To determine the intra-and inter-tester reliability of aortic pulse wave velocity (aPWV) measurements collected using applanation tonometry in individuals with spinal cord injury (SCI). Setting: Inpatient Rehabilitation Centre and outpatient Clinic in Vancouver, BC, Canada. Methods: Fifteen men and three women with traumatic SCI (age: 46 ± 16 years; C3-L1; American Spinal Injury Association Impairment Scale A-D; 2-284 months post injury) participated in two testing sessions separated by an average of 2 days. During each testing session, aPWV measurements were collected in the supine position following 10 min of rest. Arterial blood pressure waveforms were collected simultaneously by two trained raters at the carotid and femoral arterial sites using applanation tonometry. Heart rate was continuously measured using a single-lead electrocardiogram, whereas brachial blood pressures were measured at 5-min intervals using an automated device. Results: Intra-and inter-tester aPWV measurements demonstrated almost perfect reliability with intraclass correlation coefficients of 0.91 and 0.98 (Po0.001), and coefficients of variation of 5.9% and 3.4%, respectively. The smallest detectable differences (SDDs) for intra-and inter-tester measurements were 0.9 m s À1 and 0.6 m s À1 , respectively. There were no significant differences in heart rate or blood pressure between intra-and inter-testing sessions. Conclusion: Applanation tonometry measurements of aPWV are reliable in individuals with SCI. In addition, the SDDs were smaller than a clinically relevant value, suggesting that this measurement is suitable for repeated measures study designs in SCI. Spinal Cord (2014) 52, 272-275; doi:10.1038/sc.2013.176; published online 21 January 2014 Keywords: arterial stiffness; blood pressure; cardiovascular diseases; reliability INTRODUCTION Cardiovascular disease (CVD) is a leading cause of mortality in individuals living with spinal cord injury (SCI), 1,2 with the incidence of CVD occurring at earlier ages compared with able-bodied individuals. 2 In able-bodied individuals, CVD risk is attributed to non-modifiable factors such as age and gender, and modifiable factors including blood pressure, blood lipid profile, smoking status, physical activity status, body composition and diabetes management. 3 Although individuals with SCI typically present with one or more modifiable risk factors, 2,4 there is evidence to suggest that these risk factors alone may not fully explain the increased risk of CVD in this population. 5 Consequently, future investigations need to examine alternative and non-traditional CVD risk factors for individuals with SCI.Aortic pulse wave velocity (aPWV), which describes the speed of the arterial pressure waveform between the carotid and femoral arterial sites, is considered the gold-standard assessment of arterial stiffness. 6 In able-bodied individuals, elevated aPWV, indicative of increased arterial stiffness, is associated with an increased risk of C...

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“…[1][2][3] It has not been determined how changes in blood flow to the paralyzed limbs impact the development and progression of some secondary complications or how these factors are affected with different physical rehabilitation techniques. Pressure sores are a secondary complication of SCI, in which an area of skin or underlying tissue is dead or dying due to lack of blood flow.…”

Section: Introductionmentioning

confidence: 99%

Leg skin temperature with body-weight-supported treadmill and tilt-table standing training after spinal cord injury

et al. 2010

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Study design: Randomized crossover. Objectives: Effects of body-weight-supported treadmill (BWST) and tilt-table standing (TTS) training on skin temperature and blood flow after spinal cord injury (SCI). Setting: McMaster University, Canada. Methods: Seven individuals with SCI participated in BWST and TTS training (3 times per week for 4 weeks, 4-week detraining between protocols). Skin temperature was measured before and after a single session of BWST or TTS, pre-and post-training. Leg blood flow was measured at rest pre-and post-training. Results: Resting skin temperature decreased at four sites after 4 weeks of BWST training in comparison with the pre-training. Four weeks of TTS training resulted in resting skin temperature decreases posttraining at the right thigh only. Both BWST and TTS training resulted in altered reactivity of skin temperature at all sites except the right calf in response to a single session of BWST and TTS. Post-BWST training, a single session of BWST stimulated increased temperature at all sites, whereas after TTS training a single session of TTS resulted in temperature decreases at two of the six sites. No changes were observed in resting blood flow with either BWST or TTS training. Conclusion: Increased resting skin temperature and decreased skin temperature reactivity have been linked to the development of pressure sores. BWST and TTS may stimulate different skin temperature responses and the impact on pressure sore development warrants further investigation. Sponsorship: NSERC, ONF and GSSI.

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Pulse Wave Velocity for Assessment of Arterial Stiffness Among People With Spinal Cord Injury: A Pilot Study

Cited by 60 publications

References 40 publications

Peripheral vascular function in spinal cord injury: a systematic review

Peripheral vascular function in spinal cord injury: a systematic review

Applanation tonometry: a reliable technique to assess aortic pulse wave velocity in spinal cord injury

Leg skin temperature with body-weight-supported treadmill and tilt-table standing training after spinal cord injury

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