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Cardiac risk factors and prevention
Original research article
Cardiac consequences of spinal cord injury: systematic review and meta-analysis
  1. Alexandra Mackenzie Williams1,2,
  2. Cameron Marshall Gee1,3,
  3. Christine Voss4,
  4. Christopher Roy West1,2
  1. 1 International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Faculty of Education, School of Kinesiology, Vancouver, British Columbia, Canada
  4. 4 Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Christopher Roy West, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, V5Z1M9, Canada; west{at}icord.org

Abstract

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 massindex of −7.7 g/m2 (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.

  • echocardiography
  • meta-analysis
  • systemic review

https://doi.org/10.1136/heartjnl-2018-313585

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    Footnotes

    • AMW and CMG contributed equally.

    • Contributors AMW contributed to the study design, database search and data extraction, analysis and interpretation of data, drafting and revision of the manuscript. CMG contributed to the study design, database search and data extraction, analysis and interpretation of data, drafting and revision of the manuscript. CV contributed to study design, analysis of data and revision of the manuscript. CRW was responsible for the conception of the study and its design, and contributed to the analysis and interpretation of data, and drafting and revision of the manuscript. Statistical analyses conducted by CRW with consultation from CV.

    • Funding CRW is supported by Scholar awards from the Michael Smith Foundation for Health Research (MSFHR), the Rick Hansen Institute and the Heart and Stroke Foundation of Canada. AMW is supported by a postdoctoral fellowship award from MSFHR. CMG is supported by a MITACS accelerate internship.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.