International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Spinal Cord. 2022 Nov;60(11):1030-1036. doi: 10.1038/s41393-022-00820-y. Epub 2022 Jun 9.
Secondary data analysis.
To characterize heart rate (HR) changes during autonomic dysreflexia (AD) in daily life for individuals with chronic spinal cord injury (SCI).
University-based laboratory/community-based outpatient.
Cardiovascular data, previously collected during a 24-h ambulatory surveillance period in individuals with chronic SCI, were assessed. Any systolic blood pressure (SBP) increase ≥20 mmHg from baseline was identified and categorized into confirmed AD (i.e., diarized trigger), unknown (i.e., no diary entry), or unlikely AD (i.e., potential exertion driven SBP increase) groups. SBP-associated HR changes were categorized as unchanged, increased or decreased compared to baseline.
Forty-five individuals [8 females, median age and time since injury of 43 years (lower and upper quartiles 36-50) and 17 years (6-23), respectively], were included for analysis. Overall, 797 episodes of SBP increase above AD threshold were identified and classified as confirmed (n = 250, 31.4%), unknown (n = 472, 59.2%) or unlikely (n = 75, 9.4%). The median number of episodes per individual within the 24-h period was 13 (8-28). HR-decrease/increase ratio was 3:1 for confirmed and unknown, and 1.5:1 for unlikely episodes. HR changes resulting in brady-/tachycardia were 34.4%/2.8% for confirmed, 39.6%/3.4% unknown, and 26.7%/9.3% for unlikely episodes, respectively.
Our findings suggest that the majority of confirmed AD episodes are associated with a HR decrease. Using wearable-sensors-derived measures of physical activity in future studies could provide a more detailed characterization of HR changes during AD and improve AD identification.
二次数据分析。
描述慢性脊髓损伤（SCI）患者日常生活中自主神经反射障碍（AD）期间心率（HR）的变化特征。
基于大学的实验室/社区门诊。
评估先前在慢性 SCI 患者 24 小时动态监测期间收集的心血管数据。确定任何收缩压（SBP）从基线升高≥20mmHg 的情况，并将其分为确诊 AD（即，有日记记录的触发）、未知（即，无日记记录）或不太可能 AD（即，潜在的运动引起的 SBP 升高）组。将 SBP 相关的 HR 变化与基线相比分为不变、增加或减少。
共纳入 45 名患者[8 名女性，中位年龄和损伤后时间分别为 43 岁（下四分位数 36-50 岁，上四分位数 50-50 岁）和 17 岁（6-23 岁）]。总共确定了 797 次 SBP 升高超过 AD 阈值的事件，并将其分为确诊（n=250，31.4%）、未知（n=472，59.2%）或不太可能（n=75，9.4%）。24 小时内个体的平均发作次数为 13 次（8-28 次）。确诊和未知的 HR 降低/增加比为 3:1，不太可能的为 1.5:1。导致心动过缓/心动过速的 HR 变化分别为确诊的 34.4%/2.8%，未知的 39.6%/3.4%，不太可能的 26.7%/9.3%。
我们的研究结果表明，大多数确诊的 AD 发作与 HR 降低有关。在未来的研究中使用可穿戴传感器衍生的体力活动测量方法可以更详细地描述 AD 期间的 HR 变化，并提高 AD 的识别能力。
