Driussi Caterina, Ius Arianna, Bizzarini Emiliana, Antonini-Canterin Francesco, d'Andrea Antonello, Bossone Eduardo, Vriz Olga
J Spinal Cord Med. 2014 Jan;37(1):85-92. doi: 10.1179/2045772313Y.0000000161. Epub 2014 Jan 3.
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in subjects with long-term spinal cord injury (SCI). More specific recommendations for CVD prevention in this population are needed.
One hundred thirty male subjects (47 subjects with SCI and 83 able-bodied persons (ABPs), mean age 43.89 ± 1.9 and 45.44 ± 12.2 years; P = 0.48) underwent transthoracic echocardiography (TTE). The effects of age, weight, mean arterial pressure (MAP) and level of physical training on cardiac adaptations were evaluated through multiple regression analysis.
In subjects with SCI, TTE revealed increased wall thickness (P < 0.05), lower E wave, E/A ratio and early diastolic myocardial relaxation velocity on Tissue Doppler Imaging (TDI) (P < 0.05) and higher systolic myocardial contraction velocity on TDI (0.10 ± 0.02 vs. 0.09 ± 0.02 m/seconds, P = 0.002) and peak systolic pressure to end-systolic volume ratio (3.62 ± 1.39 vs. 2.82 ± 0.90, P < 0.001) compared with ABPs. Aortic diameters were larger in subjects with SCI than ABPs. Differences remained statistically significant even after adjustment for age, weight, MAP, and level of physical training. Weight and age were found to be independent variables that substantially affected left ventricular structure and function in subjects with SCI.
Subjects with post-traumatic chronic SCI and no overt cardiovascular risk factors, exhibit initial left ventricular remodeling (as assessed by TTE) compared with ABPs. Lifestyle modifications, including regular physical exercise and weight control, should be implemented in all subjects with SCI, even at a very early stage, in order to reduce cardiovascular risk and prevent the development of CVD.
心血管疾病（CVD）是长期脊髓损伤（SCI）患者发病和死亡的主要原因。该人群需要更具体的心血管疾病预防建议。
130名男性受试者（47名脊髓损伤患者和83名健全人（ABP），平均年龄分别为43.89±1.9岁和45.44±12.2岁；P = 0.48）接受了经胸超声心动图（TTE）检查。通过多元回归分析评估年龄、体重、平均动脉压（MAP）和体育锻炼水平对心脏适应性的影响。
在脊髓损伤患者中，TTE显示与健全人相比，室壁厚度增加（P < 0.05），组织多普勒成像（TDI）上E波、E/A比值和舒张早期心肌松弛速度降低（P < 0.05），TDI上收缩期心肌收缩速度更高（0.10±0.02对0.09±0.02米/秒，P = 0.002）以及收缩压峰值与收缩末期容积比值更高（3.62±1.39对2.82±0.90，P < 0.001）。脊髓损伤患者的主动脉直径大于健全人。即使在调整年龄、体重、MAP和体育锻炼水平后，差异仍具有统计学意义。发现体重和年龄是显著影响脊髓损伤患者左心室结构和功能的独立变量。
与健全人相比，创伤后慢性脊髓损伤且无明显心血管危险因素的患者表现出初始左心室重塑（通过TTE评估）。所有脊髓损伤患者，即使在非常早期阶段，都应进行生活方式改变，包括定期体育锻炼和体重控制，以降低心血管风险并预防心血管疾病的发生。
