Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2022; 10(27): 9680-9692
Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9680
Altered heart rate variability and pulse-wave velocity after spinal cord injury
Hsi-Kai Tsou, Kuan-Chung Shih, Yueh-Chiang Lin, Yi-Ming Li, Hsiao-Yu Chen
Hsi-Kai Tsou, Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung 404, Taiwan
Hsi-Kai Tsou, Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County 356, Taiwan
Hsi-Kai Tsou, College of Health, National Taichung University of Science and Technology, Taichung 403, Taiwan
Hsi-Kai Tsou, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
Kuan-Chung Shih, Research Assistant, The Rong Sing Medical Foundation, Taichung 404, Taiwan
Yueh-Chiang Lin, Research Assistant, Neurological Institute, Taichung Veterans General Hospital, Taichung 404, Taiwan
Yi-Ming Li, Research Assistant, Department of Nursing, National Taichung University of Science and Technology, Taichung 403, Taiwan
Yi-Ming Li, Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan
Hsiao-Yu Chen, Department of Nursing, National Taichung University of Science and Technology, Taichung 403, Taiwan
Author contributions: Tsou HK and Chen HY contributed to study conception and design; Tsou HK, Chen HY, Shih KC, Lin YC and Li YM contributed to data collection; Tsou HK, Chen HY and Shih KC did data analysis and interpretation; Tsou HK, Chen HY and Shih KC contributed to drafting of the article; Tsou HK and Chen HY did the critical revision of the article.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Taichung Jen-Ai Hospital (JAHIRB-108-73). All participants provided signed informed consent prior to participating in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hsiao-Yu Chen, PhD, RN, Department of Nursing, National Taichung University of Science and Technology, No. 193 Sanmin Road, West District, Taichung 403, Taiwan. hychen64@nutc.edu.tw
Received: April 6, 2022
Peer-review started: April 6, 2022
First decision: June 16, 2022
Revised: July 14, 2022
Accepted: August 15, 2022
Article in press: August 15, 2022
Published online: September 26, 2022
Processing time: 157 Days and 16.7 Hours
Abstract
BACKGROUND

Heart rate variability (HRV) and pulse-wave velocity (PWV), indicators of cardiac function, are altered in patients with spinal cord injury (SCI), suggesting that autonomic cardiac function and arterial stiffness may underlie the high risk of cardiovascular complications in these patients. No study has simultaneously investigated HRV and PWV in the same patients.

AIM

To evaluate cardiovascular complications in SCI patients by comparing HRV and PWV between patients with and without SCI.

METHODS

In this cross-sectional pilot study, patients with (n = 60) and without SCI (n = 60) were recruited from December 7, 2019 to January 21, 2020. Each participant received a five-minute assessment of HRV and the cardiovascular system using the Medicore HRV Analyzer SA-3000P. Differences in HRV and PWV parameters between participants with and without SCI were statistically examined.

RESULTS

We observed a significant difference between participants with and without SCI with respect to the standard deviation of all normal-to-normal intervals, square root of the mean sum of squared successive risk ratio interval differences, physical stress index, total power, very-low frequency, low frequency, high frequency, and arterial elasticity.

CONCLUSION

Patients with SCI have weaker sympathetic and parasympathetic activity as well as lower arterial elasticity compared to those without, suggesting that SCI may increase cardiac function loading.

Keywords: Acceleration plethysmography; Cardiac function; Heart rate variability; Pulse wave velocity; Spinal cord injury

Core Tip: Noninvasive, simultaneous assessment of heart rate variability and pulse-wave velocity showed that patients with spinal cord injury have weaker sympathetic and parasympathetic activity and lower arterial elasticity compared to those without. These findings indicate that increased cardiac function loading may underlie the high risk of cardiovascular complications in patients with spinal cord injury. Continuous dynamic monitoring of heart rate variability and pulse-wave velocity could be integrated into care programs for spinal cord injury patients to inform the development of measures to reduce stress and increase vitality.