Cardiac consequences of spinal cord injury: systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cross-sectional studies
PubMed 30262456 · doi:10.1136/heartjnl-2018-313585
What was done
A systematic review and meta-analysis searched MEDLINE and Embase for studies reporting echocardiographic measurements of left ventricular (LV) structure and function in individuals with traumatic spinal cord injury (SCI). Two independent reviewers screened articles and extracted data. Primary analyses used random-effects models to compare echocardiographic indices between individuals with SCI and able-bodied controls.
What was found
The primary meta-analysis included 22 articles comprising 474 participants. Compared with able-bodied individuals, participants with SCI showed significant reductions in: - LV stroke volume: -11.8 mL (95% CI -17.8 to -5.9, p < 0.001) - LV end-diastolic volume: -19.6 mL (95% CI -27.2 to -11.9, p < 0.001) - LV mass index: -7.7 g/m² (95% CI -11.6 to -3.8, p < 0.001) LV ejection fraction did not differ significantly between groups (95% CI -2.6% to 0.6%, p = 0.236). Individuals with SCI also demonstrated altered diastolic indices: a reduced ratio of early-to-late filling velocities (p = 0.039) and an increased ratio of early diastolic flow-to-tissue velocities (p = 0.021).
Why it matters
This review quantifies structural and functional cardiac changes following SCI, demonstrating that chronic SCI causes left ventricular atrophy and diastolic alterations despite preserved resting ejection fraction.
Limits
All included studies were observational cross-sectional comparisons with small cohorts (averaging ~21 participants per study). Measurements were restricted to resting conditions, leaving cardiac reserve under physiological stress unassessed. The abstract reports no subgroup analyses by neurological level of injury, injury severity, or time since injury.
Cited by
- supports Patients with postural orthostatic tachycardia syndrome (POTS) exhibit reduced cardiac muscle mass similar to the reduction seen in bed rest and spinal cord injury.