Abstract
Study design
Secondary data analysis.
Objectives
To characterize autonomic dysreflexia (AD) associated heart rate (HR) changes during penile vibrostimulation (PVS) and urodynamic studies (UDS).
Setting
University-based laboratory.
Methods
We analyzed blood pressure (BP) and HR data, recorded continuously, from 21 individuals (4 females; median age 41 years [lower and upper quartile, 37; 47]; median time post-injury 18 years [7; 27]; all motor-complete spinal cord injury (SCI) except one; cervical SCI = 15, thoracic [T1–T6] SCI = 6), who underwent PVS (11/21) or UDS (10/21).
Results
Overall, 47 AD episodes were recorded (i.e. PVS = 37, UDS = 10), with at least one AD episode in each participant. At AD threshold, bradycardia was observed during PVS and UDS in 43% and 30%, respectively. At AD peak (i.e., maximum increase in systolic BP from baseline), bradycardia was observed during PVS and UDS in 65% and 50%, respectively. Tachycardia was detected at AD peak only once during UDS. Our study was limited by a small cohort of participants and the distribution of sex and injury characteristics.
Conclusions
Our findings reveal that AD-associated HR changes during PVS and UDS appear to be related to the magnitude of systolic BP increases. Highly elevated systolic BP associated with bradycardia suggests the presence of severe AD. Therefore, we recommend cardiovascular monitoring (preferably with continuous beat-to-beat recordings) during PVS and UDS to detect AD early. Stopping assessments before systolic BP reaches dangerously elevated levels, could reduce the risk of life-threatening complications in this cohort.
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Data availability
The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We wish to acknowledge our colleagues at the Blusson Spinal Cord Centre. Furthermore, we would like to thank the participants who provided written informed consent for participation and publication in this study.
Funding
This study was funded by the Rick Hansen Man in Motion Research Foundation (grant number: 135774, awarded to Dr. Krassioukov). The research equipment for this study was supported by the Canadian Foundation of Innovation (CFI, grant number: 35869) and the British Columbia Knowledge Development Fund (BCKDF, grant number: 35869. Dr. Walter was supported by a 2017–2019 Michael Smith Foundation for Health Research (MSFHR) and Rick Hansen Foundation Postdoctoral Research Trainee Award (grant number 17110). Dr. Krassioukov holds the Endowed Chair in Rehabilitation Medicine.
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LR: Study conception and design, acquisition and interpretation of data, statistical analysis, drafting of the manuscript and critical revisions. ALR: Acquisition and interpretation of data, and critical revision of the manuscript for important intellectual content. SH: Acquisition and interpretation of data, and critical revision of the manuscript for important intellectual content. SE: Study conception and design, acquisition and interpretation of data, and critical revision of the manuscript for important intellectual content. MW: Study conception and design, acquisition and interpretation of data, statistical analysis, and critical revision of the manuscript for important intellectual content and supervision. AVK: Study conception and design, acquisition and interpretation of data, critical revisions and critical revision of the manuscript for important intellectual content and supervision. All authors approve the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Rietchel, L., Ramirez, A.L., Hocaloski, S. et al. Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics. Spinal Cord 61, 8–14 (2023). https://doi.org/10.1038/s41393-022-00843-5
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DOI: https://doi.org/10.1038/s41393-022-00843-5
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