Upper vs Lower Extremity Arterial Function After Spinal Cord Injury

Stoner, Lee; Sabatier, Manning J.; VanhHiel, Leslie; Groves, Danielle C.; Ripley, David L.; Palardy, Gregory J.; McCully, Kevin K.

doi:10.1080/10790268.2006.11753867

Cited by 48 publications

(60 citation statements)

References 31 publications

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“…Interestingly, the ending values of FMD in this study were still lower than those we obtained in able-bodied subjects (6.675.9 versus 12.075.2%, respectively) for our previous study, 22 suggesting that further improvements may be possible.…”

Section: Flow-mediated Dilationcontrasting

confidence: 44%

“…In a previous study, we found that FMD and arterial range were significantly lower in the legs of patients with SCI versus controls, even though the arms were similar between groups. 22 These findings suggest that interventions to improve SCI cardiovascular health should target the lower extremities.…”

Section: Introductionmentioning

confidence: 99%

“…41 The posterior tibial artery serves foot tissue, and this most likely explains why it does not see major atrophy. 22 Foot tissue is not subject to major atrophy after SCI and is unlikely to hypertrophy owing to quadriceps activation. Taken together, these findings suggest that assessments solely using resting diameter to indicate arterial size may lead to erroneous conclusions.…”

Section: Arterial Rangementioning

confidence: 99%

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Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury

et al. 2006

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Study design: Repeated measures training intervention. Objectives: To evaluate the effects of neuromuscular electrical stimulation (NMES)-induced resistance exercise therapy on lower extremity arterial health in individuals with chronic, complete spinal cord injury (SCI). We define 'arterial health' using three surrogate markers: (a) resting diameter, (b) flow-mediated dilation (FMD), and (c) arterial range. Setting: Department of Kinesiology, University of Georgia, USA. Methods: We assessed five 3675-year-old male individuals with chronic, complete SCI before, during, and after 18 weeks of training. The quadriceps femoris muscle group of both legs were trained twice a week with 4 Â 10 repetitions of unilateral, dynamic knee extensions. The health of the posterior tibial artery was assessed using a B-mode ultrasound unit equipped with a highresolution video capture device. Proximal occlusion was used to evoke ischemia for 5 min and then for 10 min. FMD was calculated using the peak diameter change (above rest) following 5 min occlusion. Arterial range was calculated using minimum (during occlusion) and maximum diameters (post 10 min occlusion). Hierarchical linear modeling accounted for the nested (repeated measures) experimental design. Results: FMD improved from 0.0870.11 mm (2.7%) to 0.1870.15 mm (6.6%) (P ¼ 0.004), and arterial range improved from 0.3670.28 to 0.9470.40 mm (P ¼ 0.001), after 18 weeks of training. Resting diameter did not significantly change. Conclusions: Home-based, self-administered NMES resistance exercise therapy consisting of 80 contractions/week improved FMD and arterial range. This provides evidence that resistance exercise therapy can improve arterial health after SCI, which may reduce the risk of future cardiovascular disease.

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Section: Flow-mediated Dilationcontrasting

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Section: Arterial Rangementioning

confidence: 99%

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Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury

et al. 2006

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“…68 In the SFA, individuals with SCI exhibit an increased absolute FMD compared with AB individuals; 69 however, this difference is no longer present when the degree of FMD is corrected for area under the shear rate curve, from the time of occluding cuff deflation to that of peak diameter attainment. 62 Such correction for the eliciting shear stress stimulus on the endothelial cell membrane is considered critical, especially in cases where arteries are compared with different baseline diameters (for example, SCI vs control).…”

Section: Conduit Arterial Function After Sci Structural Adaptationsmentioning

confidence: 99%

“…In individuals with SCI, FMD has been examined in the superficial femoral artery (SFA), 62,66,67 the posterior tibial artery, 68 brachial artery 67 and the radial artery. 68 In the SFA, individuals with SCI exhibit an increased absolute FMD compared with AB individuals; 69 however, this difference is no longer present when the degree of FMD is corrected for area under the shear rate curve, from the time of occluding cuff deflation to that of peak diameter attainment.…”

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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Peak and time‐integrated shear rates independently predict flow‐mediated dilation

Stoner

McCully

2012

J of Clinical Ultrasound

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Background:To determine whether peak and time‐integrated shear rates independently predict flow‐mediated dilation (FMD).Methods:Eleven physically active (25±5 years old) male subjects were tested. FMD was defined as the shear rate‐diameter relationship. Hierarchical linear modeling was used to estimate brachial artery diameter change with repeated measures of shear rate nested within each subject. Two models were tested: 1) FMD was induced using ischemia‐induced hyperemia (2, 4, 6, and 10 minutes); and 2) FMD was induced following transient (ischemia) and steady‐state (forearm heating and handgrip exercise) increases in shear rate. For both models we determined whether peak, in addition to time‐integrated shear rates, explained a significant portion of variation for diameter change.Results:Model 1: Time integrated shear rates explained most of the variation for diameter change. However, peak shear rate explained an additional significant portion of variation. Model 2: The transient condition resulted in significantly (p = 0.012) smaller diameter change per shear rate change than the steady‐state condition. However, when specifying peak shear rate as a covariate, the difference between conditions became nonsignificant (p = 0.138).Conclusions:Peak and time‐integrated shear rates independently predict FMD. Future studies using the FMD test should consider both parameters. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012;

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Upper vs Lower Extremity Arterial Function After Spinal Cord Injury

Cited by 48 publications

References 31 publications

Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury

Electrical stimulation-evoked resistance exercise therapy improves arterial health after chronic spinal cord injury

Peripheral vascular function in spinal cord injury: a systematic review

Peak and time‐integrated shear rates independently predict flow‐mediated dilation

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