Secondary data analysis.
To characterize autonomic dysreflexia (AD) associated heart rate (HR) changes during penile vibrostimulation (PVS) and urodynamic studies (UDS).
We analyzed blood pressure (BP) and HR data, recorded continuously, from 21 individuals (4 females; median age 41 years [lower and upper quartile, 37; 47]; median time post-injury 18 years [7; 27]; all motor-complete spinal cord injury (SCI) except one; cervical SCI = 15, thoracic [T1–T6] SCI = 6), who underwent PVS (11/21) or UDS (10/21).
Overall, 47 AD episodes were recorded (i.e. PVS = 37, UDS = 10), with at least one AD episode in each participant. At AD threshold, bradycardia was observed during PVS and UDS in 43% and 30%, respectively. At AD peak (i.e., maximum increase in systolic BP from baseline), bradycardia was observed during PVS and UDS in 65% and 50%, respectively. Tachycardia was detected at AD peak only once during UDS. Our study was limited by a small cohort of participants and the distribution of sex and injury characteristics.
Our findings reveal that AD-associated HR changes during PVS and UDS appear to be related to the magnitude of systolic BP increases. Highly elevated systolic BP associated with bradycardia suggests the presence of severe AD. Therefore, we recommend cardiovascular monitoring (preferably with continuous beat-to-beat recordings) during PVS and UDS to detect AD early. Stopping assessments before systolic BP reaches dangerously elevated levels, could reduce the risk of life-threatening complications in this cohort.
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The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
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We wish to acknowledge our colleagues at the Blusson Spinal Cord Centre. Furthermore, we would like to thank the participants who provided written informed consent for participation and publication in this study.
This study was funded by the Rick Hansen Man in Motion Research Foundation (grant number: 135774, awarded to Dr. Krassioukov). The research equipment for this study was supported by the Canadian Foundation of Innovation (CFI, grant number: 35869) and the British Columbia Knowledge Development Fund (BCKDF, grant number: 35869. Dr. Walter was supported by a 2017–2019 Michael Smith Foundation for Health Research (MSFHR) and Rick Hansen Foundation Postdoctoral Research Trainee Award (grant number 17110). Dr. Krassioukov holds the Endowed Chair in Rehabilitation Medicine.
The authors declare no competing interests.
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Rietchel, L., Ramirez, A.L., Hocaloski, S. et al. Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics. Spinal Cord (2022). https://doi.org/10.1038/s41393-022-00843-5