Valsalva maneuver pressure recovery time is prolonged following spinal cord injury with correlations to autonomically-influenced secondary complications.

Publisher: Steinkopff Country of Publication: Germany NLM ID: 9106549 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1619-1560 (Electronic) Linking ISSN: 09599851 NLM ISO Abbreviation: Clin Auton Res Subsets: MEDLINE

Publication: 2002- : Darnstadt : Steinkopff
Original Publication: Oxford, UK : Rapid Communications of Oxford, c1991-

Spinal Cord Injuries*/physiopathology ; Spinal Cord Injuries*/complications ; Valsalva Maneuver*/physiology ; Hypotension, Orthostatic*/etiology ; Hypotension, Orthostatic*/physiopathology ; Hypotension, Orthostatic*/diagnosis; Humans ; Male ; Female ; Cross-Sectional Studies ; Middle Aged ; Adult ; Autonomic Nervous System Diseases/etiology ; Autonomic Nervous System Diseases/physiopathology ; Autonomic Nervous System Diseases/diagnosis ; Recovery of Function/physiology ; Blood Pressure/physiology

Purpose: This work's purpose was to quantify rapid sympathetic activation in individuals with spinal cord injury (SCI), and to identify associated correlations with symptoms of orthostatic hypotension and common autonomically mediated secondary medical complications.
Methods: This work was a cross-sectional study of individuals with SCI and uninjured individuals. Symptoms of orthostatic hypotension were recorded using the Composite Autonomic Symptom Score (COMPASS)-31 and Autonomic Dysfunction following SCI (ADFSCI) survey. Histories of secondary complications of SCI were gathered. Rapid sympathetic activation was assessed using pressure recovery time of Valsalva maneuver. Stepwise multiple linear regression models identified contributions to secondary medical complication burden.
Results: In total, 48 individuals (24 with SCI, 24 uninjured) underwent testing, with symptoms of orthostatic hypotension higher in those with SCI (COMPASS-31, 3.3 versus 0.6, p < 0.01; ADFSCI, 21.2 versus. 3.2, p < 0.01). Pressure recovery time was prolonged after SCI (7.0 s versus. 1.7 s, p < 0.01), though poorly correlated with orthostatic symptom severity. Neurological level of injury after SCI influenced pressure recovery time, with higher injury levels associated with more prolonged time. Stepwise multiple linear regression models identified pressure recovery time as the primary explanation for variance in number of urinary tract infections (34%), histories of hospitalizations (12%), and cumulative secondary medical complication burden (24%). In all conditions except time for bowel program, pressure recovery time outperformed current clinical tools for assessing such risk.
Conclusions: SCI is associated with impaired rapid sympathetic activation, demonstrated here by prolonged pressure recovery time. Prolonged pressure recovery time after SCI predicts higher risk for autonomically mediated secondary complications, serving as a viable index for more "autonomically complete" injury.
(© 2024. Springer-Verlag GmbH Germany.)

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K23HD102663 National Institute of Child Health and Human Development; P2CHD086844 Eunice Kennedy Shriver National Institute of Child Health and Human Development

Keywords: Orthostatic hypotension; Pressure recovery time; Spinal cord injury; Valsalva maneuver

Date Created: 20240625 Date Completed: 20240830 Latest Revision: 20240830

20240830

10.1007/s10286-024-01040-5

38916658