Effect of spinal cord injury on the heart and cardiovascular fitness

Phillips, William; Kiratli, B. Jenny; Sarkarati, Mehdi; Weraarchakul, Glenn; Myers, Jonathan; Franklin, Barry A.; Parkash, Inder; Froelicher, Victor

doi:10.1016/s0146-2806(98)80003-0

Cited by 179 publications

(121 citation statements)

References 124 publications

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“…Subjects with SCI may exhibit decreased cardiac output as a consequence of impaired vasomotor reflexes, reduced sympathetic outflow and decreased venous return, secondary to the lack of muscle contraction in the extremities. 16,17 In such individuals, maintenance of blood pressure levels is thought to be dependent on the activation of the hormonal regulatory system, such as the reninangiotensin-aldosterone axis. 17 In turn, chronic upregulation of this system would potentially stimulate LV remodeling and diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 In such individuals, maintenance of blood pressure levels is thought to be dependent on the activation of the hormonal regulatory system, such as the reninangiotensin-aldosterone axis. 17 In turn, chronic upregulation of this system would potentially stimulate LV remodeling and diastolic dysfunction. 18 Nevertheless, further studies are necessary to confirm this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Altered left ventricular diastolic function in subjects with spinal cord injury

et al. 2010

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“…Third, we did not monitor physical activity, which was reported to attribute an increased FM in the SCI. 18 Fourth, we used the same criteria of MetS as for general population. The criteria of abdominal obesity might be different, because of differences in location of adipose tissue in the SCI.…”

Section: Discussionmentioning

confidence: 99%

Serum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord injury

et al. 2008

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Study Design: Cross-sectional comparison. Objective: The mortality rate is higher in individuals with spinal cord injury (SCI), and one major cause is cardiovascular disease (CVD). In the general population, the metabolic syndrome (MetS) is associated with an increased risk of CVD, and abdominal obesity is a major feature. Adipokines, secreted by adipose tissue, contribute to obesity-linked metabolic diseases. The aim of this study is to evaluate the prevalence of MetS, the components of this syndrome, especially body composition, and the relations between adipokines and body composition, in SCI individuals. Setting: Kanagawa Rehabilitation Hospital, Kanagawa, Japan. Methods: Forty-four male SCI individuals (57±13 years and 28 paraplegia) and age-matched ablebodied controls were studied. Body composition was assessed by dual-energy X-ray absorptiometry (DXA) and anthropometry (waist circumference). The visceral fat area (VFA) was measured by computed tomography (CT). Plasma adipokine levels, including that of leptin, adiponectin and plasminogen activator inhibitor-1 (PAI-1), were measured. Results: Overall, 43% of SCI individuals met the criteria for MetS. Total and regional fat mass (FM), as well as VFA, were higher, whereas total and regional lean mass, except for arm, were lower than ablebodied controls. In the SCI, leptin and PAI-1 levels were positively associated and adiponectin levels were negatively associated with waist circumference, VFA and trunk FM. In multiple regression models, only leptin level was independently associated with waist circumference, VFA and trunk FM. Conclusion: SCI individuals were predisposed to excessive abdominal obesity, and higher leptin levels were strongly associated with higher prevalence of abdominal obesity in this population.

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“…1,2 In sedentary healthy individuals, physical activity significantly decreases the risk for chronic disease. 3 Therefore, there is great interest in the use of electrical stimulation training for individuals with spinal cord injury (SCI).…”

Section: Introductionmentioning

confidence: 99%

Electrically stimulated resistance training in SCI individuals increases muscle fatigue resistance but not femoral artery size or blood flow

et al. 2005

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Study design: Longitudinal. Objectives: The purpose of this study was to evaluate the effect of lower extremity resistance training on quadriceps fatigability, femoral artery diameter, and femoral artery blood flow. Setting: Academic Institution. Methods: Five male chronic spinal cord injury (SCI) individuals (American Spinal Injury Association (ASIA): A complete; C5-T10; 3675 years old) completed 18 weeks of home-based neuromuscular electrical stimulation (NMES) resistance training. Subjects trained the quadriceps muscle group twice a week with four sets of 10 dynamic knee extensions against resistance while in a seated position. All measurements were made before training and after 8, 12, and 18 weeks of training. Ultrasound was used to measure femoral artery diameter and blood flow. Blood flow was measured before and after 5 and 10 min of distal cuff occlusion, and during a 4-min isometric electrical stimulation fatigue protocol. Results: Training resulted in significant increases in weight lifted and muscle mass, as well as a 60% reduction in muscle fatigue (P ¼ 0.001). However, femoral arterial diameter did not increase. The range was 0.4470.03 to 0.4670.05 cm over the four time points (P ¼ 0.70). Resting, reactive hyperemic, and exercise blood flow did not appear to change with training. Conclusion: NMES resistance training improved muscle size and fatigue despite an absence of response in the supplying vasculature. These results suggest that the decreases in arterial caliber and blood flow seen with SCI are not tightly linked to muscle mass and fatigue resistance. In addition, muscle fatigue in SCI patients can be improved without increases in arterial diameter or blood flow capacity.

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Effect of spinal cord injury on the heart and cardiovascular fitness

Cited by 179 publications

References 124 publications

Altered left ventricular diastolic function in subjects with spinal cord injury

Altered left ventricular diastolic function in subjects with spinal cord injury

Serum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord injury

Electrically stimulated resistance training in SCI individuals increases muscle fatigue resistance but not femoral artery size or blood flow

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