Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

Lasse Malmqvist; Tor Biering-Sørensen; Kim Bartholdy; A Krassioukov; K-L Welling; J H Svendsen; A Kruse; Birgitte Hansen; F Biering-Sørensen

doi:10.1038/sc.2014.195

Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

Lasse Malmqvist, Tor Biering-Sørensen, Kim Bartholdy, A Krassioukov, K-L Welling, J H Svendsen, A Kruse, Birgitte Hansen, F Biering-Sørensen

Department of Clinical Medicine

18 Citations (Scopus)

Abstract

OBJECTIVES: Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI.

METHODS: As soon as possible after SCI patients who met the inclusion criteria had 24 h Holter monitoring of their cardiac rhythm, additional Holter monitoring were performed 1, 2, 3 and 4 weeks after SCI.

RESULTS: Fifty SCI patients were included. A significant increase in standard deviation of the average normal-to-normal (SDANN) sinus intervals was seen in the first month after injury (P=0.008). The increase was only significant in C1-T5 incomplete patients and in patients who did not experience one or more episodes of cardiac arrest. Significant lower values of Low Frequency Power, Total Power and the Low Frequency over High Frequency ratio were seen in the C1-T5 SCI patients compared with T6-T12 SCI patients.

CONCLUSIONS: The rise in SDANN in the incomplete C1-T5 patients could be due to spontaneous functional recovery caused by synaptic plasticity or remodelling of damaged axons. That the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1-C8 and T1-T5 SCI patients has yet to be reached.

Original language	English
Journal	Spinal Cord
Volume	53
Issue number	1
Pages (from-to)	54-58
Number of pages	5
ISSN	1362-4393
DOIs	https://doi.org/10.1038/sc.2014.195
Publication status	Published - 10 Jan 2015

Keywords

Adult
Aged
Aged, 80 and over
Autonomic Nervous System Diseases
Cervical Vertebrae
Denmark
Female
Fourier Analysis
Heart Rate
Humans
Linear Models
Lumbar Vertebrae
Male
Middle Aged
Spinal Cord Injuries
Thoracic Vertebrae
Time Factors
Young Adult

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title = "Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses",

abstract = "OBJECTIVES: Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI.METHODS: As soon as possible after SCI patients who met the inclusion criteria had 24 h Holter monitoring of their cardiac rhythm, additional Holter monitoring were performed 1, 2, 3 and 4 weeks after SCI.RESULTS: Fifty SCI patients were included. A significant increase in standard deviation of the average normal-to-normal (SDANN) sinus intervals was seen in the first month after injury (P=0.008). The increase was only significant in C1-T5 incomplete patients and in patients who did not experience one or more episodes of cardiac arrest. Significant lower values of Low Frequency Power, Total Power and the Low Frequency over High Frequency ratio were seen in the C1-T5 SCI patients compared with T6-T12 SCI patients.CONCLUSIONS: The rise in SDANN in the incomplete C1-T5 patients could be due to spontaneous functional recovery caused by synaptic plasticity or remodelling of damaged axons. That the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1-C8 and T1-T5 SCI patients has yet to be reached.",

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author = "Lasse Malmqvist and Tor Biering-S{\o}rensen and Kim Bartholdy and A Krassioukov and K-L Welling and Svendsen, {J H} and A Kruse and Birgitte Hansen and F Biering-S{\o}rensen",

year = "2015",

month = jan,

day = "10",

doi = "10.1038/sc.2014.195",

language = "English",

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pages = "54--58",

journal = "Spinal Cord",

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T1 - Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

AU - Malmqvist, Lasse

AU - Biering-Sørensen, Tor

AU - Bartholdy, Kim

AU - Krassioukov, A

AU - Welling, K-L

AU - Svendsen, J H

AU - Kruse, A

AU - Hansen, Birgitte

AU - Biering-Sørensen, F

PY - 2015/1/10

Y1 - 2015/1/10

N2 - OBJECTIVES: Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI.METHODS: As soon as possible after SCI patients who met the inclusion criteria had 24 h Holter monitoring of their cardiac rhythm, additional Holter monitoring were performed 1, 2, 3 and 4 weeks after SCI.RESULTS: Fifty SCI patients were included. A significant increase in standard deviation of the average normal-to-normal (SDANN) sinus intervals was seen in the first month after injury (P=0.008). The increase was only significant in C1-T5 incomplete patients and in patients who did not experience one or more episodes of cardiac arrest. Significant lower values of Low Frequency Power, Total Power and the Low Frequency over High Frequency ratio were seen in the C1-T5 SCI patients compared with T6-T12 SCI patients.CONCLUSIONS: The rise in SDANN in the incomplete C1-T5 patients could be due to spontaneous functional recovery caused by synaptic plasticity or remodelling of damaged axons. That the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1-C8 and T1-T5 SCI patients has yet to be reached.

AB - OBJECTIVES: Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI.METHODS: As soon as possible after SCI patients who met the inclusion criteria had 24 h Holter monitoring of their cardiac rhythm, additional Holter monitoring were performed 1, 2, 3 and 4 weeks after SCI.RESULTS: Fifty SCI patients were included. A significant increase in standard deviation of the average normal-to-normal (SDANN) sinus intervals was seen in the first month after injury (P=0.008). The increase was only significant in C1-T5 incomplete patients and in patients who did not experience one or more episodes of cardiac arrest. Significant lower values of Low Frequency Power, Total Power and the Low Frequency over High Frequency ratio were seen in the C1-T5 SCI patients compared with T6-T12 SCI patients.CONCLUSIONS: The rise in SDANN in the incomplete C1-T5 patients could be due to spontaneous functional recovery caused by synaptic plasticity or remodelling of damaged axons. That the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1-C8 and T1-T5 SCI patients has yet to be reached.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Autonomic Nervous System Diseases

KW - Cervical Vertebrae

KW - Denmark

KW - Female

KW - Fourier Analysis

KW - Heart Rate

KW - Humans

KW - Linear Models

KW - Lumbar Vertebrae

KW - Male

KW - Middle Aged

KW - Spinal Cord Injuries

KW - Thoracic Vertebrae

KW - Time Factors

KW - Young Adult

U2 - 10.1038/sc.2014.195

DO - 10.1038/sc.2014.195

M3 - Journal article

C2 - 25403499

SN - 1362-4393

VL - 53

SP - 54

EP - 58

JO - Spinal Cord

JF - Spinal Cord

IS - 1

ER -

Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

Abstract

Keywords

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