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Cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injuries

Hill, Mattias LU orcid ; Jörgensen, Sophie LU ; Engström, Gunnar LU ; Persson, Margaretha LU orcid ; Platonov, Pyotr G LU ; Hamrefors, Viktor LU orcid and Lexell, Jan LU (2024) In Journal of Spinal Cord Medicine p.1-14
Abstract

OBJECTIVES: To examine cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injury (SCI) compared with the general population, and explore if the neurological level of injury (NLI) is related to cardiovascular autonomic function.

DESIGN: Population-based cross-sectional study with matched controls.

SETTING: Outpatient SCI unit in Southern Sweden.

PARTICIPANTS: Twenty-five individuals (20% women, mean age 58 years and mean time since injury 28 years, NLI C2-T6, American Spinal Injury Association Impairment Scale A-C) from the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA). Matched controls were obtained from the... (More)

OBJECTIVES: To examine cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injury (SCI) compared with the general population, and explore if the neurological level of injury (NLI) is related to cardiovascular autonomic function.

DESIGN: Population-based cross-sectional study with matched controls.

SETTING: Outpatient SCI unit in Southern Sweden.

PARTICIPANTS: Twenty-five individuals (20% women, mean age 58 years and mean time since injury 28 years, NLI C2-T6, American Spinal Injury Association Impairment Scale A-C) from the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA). Matched controls were obtained from the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) at a ratio of 5:1.

INTERVENTIONS: Not applicable.

OUTCOME MEASURES: 24 h electrocardiography and deep breathing tests. 24 h ambulatory blood pressure (BP) monitoring and orthostatic BP tests.

RESULTS: In individuals with SCI compared with controls, heart rate variability (24h mean SD of the normal-to-normal interval 112 ms vs 145 ms, P < 0.001) and diastolic orthostatic BP increase (2.0 and 9.4 mmHg, P < 0.001), were significantly lower, whereas BP variability was significantly higher (24h mean systolic SD
BP 17.8 mmHg vs 15.7 mmHg, P = 0.029). Circadian patterns of heart rate variability and BP (lack of nocturnal dip) were significantly different among the individuals with SCI than controls. Higher NLI was significantly (P < 0.05) correlated with impairments to various cardiovascular autonomic function variables.

CONCLUSIONS: This exploratory study indicates that cardiovascular autonomic function is impaired in middle-aged people with long-term cervical and upper thoracic SCI compared with the general non-SCI population, and more pronounced with a higher NLI. Future research is needed to understand the pathophysiological mechanisms underlying these impairments, and the prognostic significance for individuals with SCI.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03515122.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of Spinal Cord Medicine
pages
1 - 14
publisher
Taylor & Francis
external identifiers
  • scopus:85206251063
  • pmid:39392470
ISSN
2045-7723
DOI
10.1080/10790268.2024.2403791
language
English
LU publication?
yes
id
dffabe98-ea56-4837-8551-e87e78836f40
date added to LUP
2024-11-14 23:32:58
date last changed
2024-11-15 08:44:34
@article{dffabe98-ea56-4837-8551-e87e78836f40,
  abstract     = {{<p>OBJECTIVES: To examine cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injury (SCI) compared with the general population, and explore if the neurological level of injury (NLI) is related to cardiovascular autonomic function.</p><p>DESIGN: Population-based cross-sectional study with matched controls.</p><p>SETTING: Outpatient SCI unit in Southern Sweden.</p><p>PARTICIPANTS: Twenty-five individuals (20% women, mean age 58 years and mean time since injury 28 years, NLI C2-T6, American Spinal Injury Association Impairment Scale A-C) from the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA). Matched controls were obtained from the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) at a ratio of 5:1.</p><p>INTERVENTIONS: Not applicable.</p><p>OUTCOME MEASURES: 24 h electrocardiography and deep breathing tests. 24 h ambulatory blood pressure (BP) monitoring and orthostatic BP tests.</p><p>RESULTS: In individuals with SCI compared with controls, heart rate variability (24h mean SD of the normal-to-normal interval 112 ms vs 145 ms, P &lt; 0.001) and diastolic orthostatic BP increase (2.0 and 9.4 mmHg, P &lt; 0.001), were significantly lower, whereas BP variability was significantly higher (24h mean systolic SD<br>
 BP 17.8 mmHg vs 15.7 mmHg, P = 0.029). Circadian patterns of heart rate variability and BP (lack of nocturnal dip) were significantly different among the individuals with SCI than controls. Higher NLI was significantly (P &lt; 0.05) correlated with impairments to various cardiovascular autonomic function variables.<br>
 </p><p>CONCLUSIONS: This exploratory study indicates that cardiovascular autonomic function is impaired in middle-aged people with long-term cervical and upper thoracic SCI compared with the general non-SCI population, and more pronounced with a higher NLI. Future research is needed to understand the pathophysiological mechanisms underlying these impairments, and the prognostic significance for individuals with SCI.</p><p>TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03515122.</p>}},
  author       = {{Hill, Mattias and Jörgensen, Sophie and Engström, Gunnar and Persson, Margaretha and Platonov, Pyotr G and Hamrefors, Viktor and Lexell, Jan}},
  issn         = {{2045-7723}},
  language     = {{eng}},
  month        = {{10}},
  pages        = {{1--14}},
  publisher    = {{Taylor & Francis}},
  series       = {{Journal of Spinal Cord Medicine}},
  title        = {{Cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injuries}},
  url          = {{http://dx.doi.org/10.1080/10790268.2024.2403791}},
  doi          = {{10.1080/10790268.2024.2403791}},
  year         = {{2024}},
}