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1 Veterans Affairs Medical Center, Spinal Cord Injury and Medical Services, Bronx 10468; 2 Spinal Cord Damage Research Center and 3 Department of Medicine and 4 Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York 10029; 5 Department of Rehabilitation Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032; and 6 Osteopathic Medical Center, Des Moines University, Des Moines, Iowa 50312
The purpose of this study was to examine cardiac hemodynamics during acute head-up tilt (HUT) and calf venous function during acute head-down tilt (HDT) in subjects with paraplegia compared with sedentary nondisabled controls. Nineteen paraplegic males (below T6) and nine age-, height-, and weight-matched control subjects participated. Heart rate, stroke volume, and cardiac output were assessed using the noninvasive acetylene uptake method. Venous vascular function of the calf was assessed using venous occlusion plethysmography. After supine measurements were collected, the table was moved to 10° HDT followed by the three levels of HUT (10, 35, and 75°) in random order. Cardiac hemodynamics were similar between the groups at all positions. Calf circumference was significantly reduced in the paraplegic group compared with the control group (P < 0.001). Venous capacitance and compliance were significantly reduced in the paraplegic compared with control group at supine and HDT. Neither venous capacitance (P = 0.37) nor compliance (P = 0.19) increased from supine with 10° HDT in the paraplegic group. A significant linear relationship was established between supine venous compliance and supine cardiac output in the control group (r = 0.80, P < 0.02) but not in the paraplegic group. The findings of reduced calf circumference and similar venous capacitance at supine rest and 10° HDT in the paraplegic group imply that structural changes may have limited venous dispensability in individuals with chronic paraplegia. Furthermore, the lack of a relationship between supine venous compliance and supine cardiac output suggests that cardiac homeostasis does not rely on venous compliance in subjects with paraplegia.
spinal cord injury; head-up tilt; venous capacitance; skeletal muscle mass atrophy
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