TY - JOUR
T1 - Hemodynamic responses to head-up tilt after spinal cord injury support a role for the mid-thoracic spinal cord in cardiovascular regulation
AU - Bluvshtein, V.
AU - Korczyn, A. D.
AU - Akselrod, S.
AU - Pinhas, I.
AU - Gelernter, I.
AU - Catz, A.
N1 - Funding Information:
This study was supported by the Unit of Medical Services, Rehabilitation Department, Ministry of Defense and by the Tel-Aviv University Research Fund. Rimed Ltd., Raanana, Israel lent the TCD device for the study.
PY - 2011/2
Y1 - 2011/2
N2 - Background:Data showing a role for the mid-thoracic spinal cord (SC) in the control of hemodynamic changes is scarce despite existing evidence for its involvement in autonomic regulation.Study design:On the basis of the open label prospective series comparing three groups.Objective:To determine whether the mid-thoracic SC has a role in hemodynamic regulation during head-up tilt (HUT).Setting:Spinal Research Laboratory, Loewenstein Rehabilitation Hospital.Methods:A total of 13 healthy control subjects, 10 patients with T 4-T 6 paraplegia and 11 with C 4-C 7 tetraplegia were examined during supine rest and during HUT. Heart rate (HR), blood pressure (BP), HR spectral components (lower frequency fluctuation (LF), higher frequency fluctuations (HF) and LF/HF) and cerebral blood flow velocity (CBFV) were continuously measured or calculated.Results:BP response to HUT differed among these groups (P<0.02). During HUT, BP decreased markedly in the tetraplegia group (from a mean value of 81.65 to 67.69 mm Hg), and increased in the control groups (from 92.89 to 95.44 mm Hg) and in the T 4-T 6 paraplegia group (from 96.24 to 97.86 mm Hg). Significant correlation was found in the control and tetraplegia groups between increases in HR LF/HF and HR at HUT (r>0.7; P<0.01). No such correlation was found in the paraplegia group. HUT effect on HR and CBFV was significant in all groups (P<0.001), but group differences were statistically non-significant.Conclusion:Findings were generally compatible with those of comparable previously published studies, but they also support a role for the mid-thoracic SC in hemodynamic regulation, which should be considered in clinical setting and in research.
AB - Background:Data showing a role for the mid-thoracic spinal cord (SC) in the control of hemodynamic changes is scarce despite existing evidence for its involvement in autonomic regulation.Study design:On the basis of the open label prospective series comparing three groups.Objective:To determine whether the mid-thoracic SC has a role in hemodynamic regulation during head-up tilt (HUT).Setting:Spinal Research Laboratory, Loewenstein Rehabilitation Hospital.Methods:A total of 13 healthy control subjects, 10 patients with T 4-T 6 paraplegia and 11 with C 4-C 7 tetraplegia were examined during supine rest and during HUT. Heart rate (HR), blood pressure (BP), HR spectral components (lower frequency fluctuation (LF), higher frequency fluctuations (HF) and LF/HF) and cerebral blood flow velocity (CBFV) were continuously measured or calculated.Results:BP response to HUT differed among these groups (P<0.02). During HUT, BP decreased markedly in the tetraplegia group (from a mean value of 81.65 to 67.69 mm Hg), and increased in the control groups (from 92.89 to 95.44 mm Hg) and in the T 4-T 6 paraplegia group (from 96.24 to 97.86 mm Hg). Significant correlation was found in the control and tetraplegia groups between increases in HR LF/HF and HR at HUT (r>0.7; P<0.01). No such correlation was found in the paraplegia group. HUT effect on HR and CBFV was significant in all groups (P<0.001), but group differences were statistically non-significant.Conclusion:Findings were generally compatible with those of comparable previously published studies, but they also support a role for the mid-thoracic SC in hemodynamic regulation, which should be considered in clinical setting and in research.
KW - hemodynamics
KW - power spectrum analysis
KW - spinal cord injuries
KW - tilt-table test
KW - transcranial Doppler ultrasonography
UR - http://www.scopus.com/inward/record.url?scp=79551684260&partnerID=8YFLogxK
U2 - 10.1038/sc.2010.98
DO - 10.1038/sc.2010.98
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AN - SCOPUS:79551684260
SN - 1362-4393
VL - 49
SP - 251
EP - 256
JO - Spinal Cord
JF - Spinal Cord
IS - 2
ER -