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1 Department of Medicine, Veterans Affairs Medical Center, Bronx, NY, USA; SCI, Spinal Cord Damage Research Center, Bronx, NY, USA; Department of Rehabilitation, Mount Sinai School of Medicine, New York, NY, USA
2 Department of Rehabilitation, College of Physicians and Surgeons, Columbia University, New York, NY, USA
3 Department of Rehabilitation, Des Moines University-Osteopathic Medical Center, Des Moines, IA, USA
4 Department of Medicine, Veterans Affairs Medical Center, Bronx, NY, USA; SCI, Spinal Cord Damage Research Center, Bronx, NY, USA
* To whom correspondence should be addressed. E-mail: jwecht{at}hotmail.com.
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 (P) compared to sedentary non-disabled controls (C). Nineteen P males (below T-6) and nine age, height and weight-matched C subjects participated. Heart rate, stroke volume and cardiac output were assessed using the non-invasive acetylene uptake method. Venous vascular function of the calf was assessed using venous occlusion plethysmography. After supine measures were collected, the table was moved to 10° HDT followed by the three levels of HUT (10°, 35°, 75°), in random order. Cardiac hemodynamics were similar between the groups at all positions. Calf circumference was significantly reduced in the P group compared to the C group (P<0.001). Venous capacitance and compliance were significantly reduced in the P compared to C group at all positions. Neither venous capacitance (P=0.37) or compliance (P=0.19) increased from supine with 10° HDT in the P group. A significant linear relationship was established between supine venous compliance and supine cardiac output in the C (r=0.80, P<0.02) but not in the P group. The findings of reduced calf circumference and similar venous capacitance at supine rest and 10° HDT in the P group imply that structural changes may have limited venous dispensability in individuals with chronic paraplegia. Further, the lack of a relationship between supine venous compliance and supine cardiac output suggests that cardiac homeostasis is independent of venous compliance in subjects with paraplegia.
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