Comparison of autonomic nervous system dysfunction, arterial stiffness, and heart rate recovery according to spinal cord injury level

Journal of International Medical Research, 2024 · DOI: 10.1177/03000605241266591 · Published: August 1, 2024

Spinal Cord Injury Cardiovascular Science Neurology

Simple Explanation

This study investigates how the level of spinal cord injury (SCI) affects the autonomic nervous system (ANS), arterial stiffness, and heart rate recovery (HRR) after exercise. Patients were divided into two groups based on their injury level: those with injuries at or above the T6 vertebra (Group A) and those with injuries below T6 (Group B). The research found that Group A had more ANS dysfunction and slower HRR, while Group B had greater arterial stiffness. These differences may help in creating better cardiovascular disease prevention strategies for SCI patients.

Study Duration

March 2018 and February 2022

Participants

51 patients with SCI: Group A (NLI at and above T6) and Group B (NLI below T6)

Evidence Level

Observational Study

Key Findings

1
Patients with SCI at or above T6 (Group A) had significantly higher values in the head-up tilt test and 24-hour ambulatory blood pressure monitoring, indicating greater autonomic nervous system dysfunction.
2
Patients with SCI below T6 (Group B) had significantly higher pulse wave velocity (PWV) values on both sides, indicating greater arterial stiffness compared to Group A.
3
One minute after the exercise tolerance test, Group A had significantly slower heart rate recovery compared to Group B.

Research Summary

This study aimed to understand how the level of spinal cord injury (SCI) affects autonomic nervous system (ANS) dysfunction, arterial stiffness, and heart rate recovery (HRR). The study found that patients with SCI at or above T6 had greater ANS dysfunction and slower HRR, while those with SCI below T6 had greater arterial stiffness. The conclusion suggests tailoring cardiovascular disease prevention strategies based on the neurological level of injury in SCI patients, focusing on reducing arterial stiffness for lower-level injuries and improving autonomic function for upper-level injuries.

Practical Implications

Tailored Interventions

Cardiovascular disease prevention strategies for SCI patients should be tailored based on the neurological level of injury.

Lifestyle Improvements

For patients with SCI below T6, lifestyle improvements focusing on reducing arterial stiffness may be crucial.

Endurance Exercises

For patients with SCI at or above T6, endurance exercises are likely vital for overcoming autonomic nervous system dysfunction.

Study Limitations

1
The study did not analyze all risk factors for CVD, such as dyslipidemia, family history, and smoking status.
2
Blood pressure was measured after 3 minutes of tilting, which may have missed orthostatic hypotension episodes.
3
The sample size was relatively small due to the single-center study design.

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