Cardiac consequences of spinal cord injury: systematic review and meta-analysis

被引:32
|
作者
Williams, Alexandra Mackenzie [1 ,2 ]
Gee, Cameron Marshall [1 ,3 ]
Voss, Christine [4 ]
West, Christopher Roy [1 ,2 ]
机构
[1] Univ British Columbia, Int Collaborat Repair Discoveries ICORD, Vancouver, BC V5Z 1M9, Canada
[2] Univ British Columbia, Fac Med, Dept Cellular & Physiol Sci, Vancouver, BC, Canada
[3] Fac Educ, Sch Kinesiol, Vancouver, BC, Canada
[4] Univ British Columbia, Dept Pediat, Fac Med, Vancouver, BC, Canada
关键词
echocardiography; meta-analysis; systemic review; VENTRICULAR DIASTOLIC FUNCTION; PHYSICAL-ACTIVITY; BLOOD-VOLUME; EXERCISE; MASS; RECOMMENDATIONS; QUANTIFICATION; INDIVIDUALS; DYSFUNCTION; HEMOGLOBIN;
D O I
10.1136/heartjnl-2018-313585
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective Conduct a meta-analysis to determine the impact of traumatic spinal cord injury (SCI) on echocardiographic measurements of left ventricular (LV) structure and function. Methods MEDLINE and Embase were used for primary searches of studies reporting LV echocardiographic data in individuals with SCI. Of 378 unique citations, 36 relevant full-text articles were retrieved, and data from 27 studies were extracted for meta-analyses. Literature searches, article screening and data extraction were completed by two independent reviewers and compared for agreement. Primary analyses compared echocardiographic indices between individuals with SCI and able-bodied individuals, using a random effects model. Results Data are reported as pooled effect estimates (95% CI). Data from 22 articles (474 participants) were included in the primary meta-analysis. Compared with able-bodied individuals, individuals with SCI had reductions to LV stroke volume of 11.8 mL (95% CI -17.8 to -5.9, p<0.001), end-diastolic volume of 19.6 mL (95% CI -27.2 to -11.9, p<0.001) and LV mass(index) of -7.7 g/m(2) (95% CI -11.6 to -3.8, p<0.001), but ejection fraction was not different between the groups (95% CI -2.6% to 0.6%, p=0.236). Individuals with SCI also had altered indices of diastolic function, specifically a lowered ratio of early-to-late filling velocities (p=0.039), and augmented ratio of early diastolic flow-to-tissue velocities (p=0.021). Conclusions Individuals with SCI have smaller LV volumes and mass, and altered systolic and diastolic function. While this meta-analysis demonstrates important alterations to echocardiographic measures of cardiac structure and function at rest, future work should consider the impacts of SCI on the heart's capacity or 'reserve' to respond to physiological challenges. PROSPERO registration number CRD42017072333.
引用
收藏
页码:217 / 225
页数:9
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