International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Neuromodulation. 2024 Oct;27(7):1164-1176. doi: 10.1016/j.neurom.2023.07.010. Epub 2023 Sep 2.
There are many potential etiologies of impaired cardiovascular control, from chronic stress to neurodegenerative conditions or central nervous system lesions. Since 1959, spinal cord stimulation (SCS) has been reported to modulate blood pressure (BP), heart rate (HR), and HR variability (HRV), yet the specific stimulation sites and parameters to induce a targeted cardiovascular (CV) change for mitigating abnormal hemodynamics remain unclear. To investigate the ability and parameters of SCS to modulate the CV, we reviewed clinical studies using SCS with reported HR, BP, or HRV findings.
A keyword-based electronic search was conducted through MEDLINE, Embase, and PubMed data bases, last searched on February 3, 2023. Inclusion criteria were studies with human participants receiving SCS with comparison with SCS turned off, with reporting of either HR, HRV, or BP findings. Non-English studies, conference abstracts, and studies not reporting standalone effects of SCS when comparing SCS with non-SCS interventions were excluded. Results were plotted for visual analysis. When available, participant-specific stimulation parameters and effects were extracted and quantitatively analyzed using ordinary least squares regression.
A total of 59 studies were included in this review; 51 studies delivered SCS invasively through implanted/percutaneous leads. Eight studies used noninvasive, transcutaneous electrodes. We found numerous reports of cervical, high thoracic, and mid-to-low thoracolumbar SCS increasing resting BP, and cervical/mid-to-low thoracolumbar SCS decreasing BP. The effect of SCS location on HR and HRV was equivocal. We were unable to analyze stimulation parameters owing to inadequate parameter reporting in many publications.
Our findings suggest CV neuromodulation, particularly BP modulation, with SCS to be a promising frontier. Further research with larger randomized controlled trials and detailed reporting of SCS parameters will be necessary for appropriate evaluation of SCS as a CV therapy.
心血管控制受损的潜在病因很多，从慢性应激到神经退行性疾病或中枢神经系统损伤。自 1959 年以来，脊髓刺激（SCS）已被报道可调节血压（BP）、心率（HR）和心率变异性（HRV），但用于诱导针对心血管（CV）变化以减轻异常血液动力学的特定刺激部位和参数仍不清楚。为了研究 SCS 调节 CV 的能力和参数，我们回顾了使用 SCS 并报告 HR、BP 或 HRV 结果的临床研究。
通过 MEDLINE、Embase 和 PubMed 数据库进行基于关键字的电子搜索，最后一次搜索时间为 2023 年 2 月 3 日。纳入标准为接受 SCS 治疗且与 SCS 关闭相比有 HR、HRV 或 BP 结果报告的人类参与者研究。排除非英语研究、会议摘要以及未报告当 SCS 与非 SCS 干预措施进行比较时 SCS 单独作用的研究。结果进行了可视化分析。当有可用数据时，提取并使用普通最小二乘法回归对参与者特定的刺激参数和效果进行定量分析。
本综述共纳入 59 项研究；51 项研究通过植入/经皮导线进行 SCS 治疗。8 项研究使用非侵入性、经皮电极。我们发现许多报告称颈椎、高胸段和中至低胸段 SCS 可增加静息血压，而颈椎/中至低胸段 SCS 可降低血压。SCS 位置对 HR 和 HRV 的影响尚无定论。由于许多出版物中参数报告不足，我们无法对刺激参数进行分析。
我们的研究结果表明，SCS 对心血管的神经调节作用，特别是血压调节作用，具有广阔的应用前景。需要进一步开展更大规模的随机对照试验和详细报告 SCS 参数的研究，以适当评估 SCS 作为 CV 治疗的效果。
