Heart rate and blood pressure response improve the prediction of orthostatic cardiovascular dysregulation in persons with chronic spinal cord injury.
Heart rate and blood pressure response improve the prediction of orthostatic cardiovascular dysregulation in persons with chronic spinal cord injury.
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DOI：
10.14814/phy2.14617
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发表时间：
2020-10
影响因子：
2.5
通讯作者：
Harkema SJ
中科院分区：
文献类型：
--
作者：
Wang S;Wecht JM;Legg Ditterline B;Ugiliweneza B;Maher MT;Lombard AT;Aslan SC;Ovechkin AV;Bethke B;Gunter JTH;Harkema SJ
脊髓损伤（SCI）后不稳定的血压不是常规检查，而是通过损伤的水平和完整性（即，美国脊髓损伤协会损伤量表AIS分类）。我们的目的是在一个大型慢性SCI患者队列中研究仰卧起坐试验的血流动力学反应，以更好地了解该人群的心血管功能。记录了SCI患者（n = 159）和非受伤患者（n = 48）的连续血压和心电图。我们发现直立性低血压发生在每个级别和AIS分类（n = 36）。此外，45名慢性SCI患者的血压下降不符合直立性低血压的标准，但伴随着心率的急剧增加，反映了直立性不耐受。对坐姿的血流动力学反应的聚类分析确定了8种不同的模式，表明不同的自主神经反应的血压和心率之间的相互作用，在直立应激。心率和血压的聚类分析对直立性心血管失调的诊断更敏感。这表明血压不稳定性不能通过SCI的水平和完整性来预测，并且直立性低血压的共识声明定义不足以表征直立性应激期间血压和心率反应的变异性。血压和心率反应都需要表征SCI后的自主神经功能。直立性低血压的定义，仅仅基于血压的绝对下降，不足以描述直立性应激期间不良的血压和心率反应。心率和血压相互作用的聚类分析对诊断直立性心血管失调更敏感。这些结果表明，不能通过SCI的水平和完整性来预测心血管不稳定性，并且需要血压和心率反应来表征SCI后的自主神经功能障碍。
Unstable blood pressure after spinal cord injury (SCI) is not routinely examined but rather predicted by level and completeness of injury (i.e., American Spinal Injury Association Impairment Scale AIS classification). Our aim was to investigate hemodynamic response to a sit‐up test in a large cohort of individuals with chronic SCI to better understand cardiovascular function in this population. Continuous blood pressure and ECG were recorded from individuals with SCI (n = 159) and non‐injured individuals (n = 48). We found orthostatic hypotension occurred within each level and AIS classification (n = 36). Moreover, 45 individuals with chronic SCI experienced a drop in blood pressure that did not meet the criteria for orthostatic hypotension, but was accompanied by dramatic increases in heart rate, reflecting orthostatic intolerance. A cluster analysis of hemodynamic response to a seated position identified eight distinct patterns of interaction between blood pressure and heart rate during orthostatic stress indicating varied autonomic responses. Algorithmic cluster analysis of heart rate and blood pressure is more sensitive to diagnosing orthostatic cardiovascular dysregulation. This indicates blood pressure instability cannot be predicted by level and completeness of SCI, and the consensus statement definition of orthostatic hypotension is insufficient to characterize the variability of blood pressure and heart rate responses during orthostatic stress. Both blood pressure and heart rate responses are needed to characterize autonomic function after SCI. The definition of orthostatic hypotension, based solely on an absolute decrease in blood pressure, is insufficient to characterize the adverse blood pressure and heart rate responses during orthostatic stress. Algorithmic cluster analysis of heart rate and blood pressure interaction is more sensitive to diagnosing orthostatic cardiovascular dysregulation. These results demonstrate that cardiovascular instability cannot be predicted by level and completeness of SCI, and both blood pressure and heart rate responses are needed to characterize autonomic dysfunction after SCI.