Cardiac Autonomic Assessment and Diastolic Function in Individuals with Spinal Cord Injury
The primary purpose of this thesis was to examine the validity and reproducibility of the QT-variability index (QTVI) as a measure of cardiac autonomic function in individuals with spinal cord injury (SCI). The secondary purpose was to investigate the influence of cardiac autonomic activity and blood volume on diastolic function in individuals with SCI. Results from Study 1 showed that the QTVI increased when participants performed a cardiovascular (CV) stress maneuver, and subsequently returned to baseline after blocking sympathetic outflow via metoprolol. Moreover, while participants were resting, the QTVI increased after blocking parasympathetic activity via atropine. These results suggest that the QTVI may reflect both cardiac sympathetic and parasympathetic activity in those with incomplete SCI, depending on the autonomic state of the individual. Results from Study 2 demonstrate high day-to-day reproducibility of the QTVI in participants with SCI, regardless of injury level, and also in those with high level injuries who may have reduced cardiac sympathetic regulation. Results from Study 3 showed that indices of cardiac parasympathetic activity (HRV and QTVI) were correlated with left ventricular filling in able-bodied individuals but not in individuals with SCI, suggesting a disconnect between cardiac parasympathetic activity and diastolic function after SCI. In addition, for the able-bodied group, the cold face test (CFT) increased vagal activity which was associated with bradycardia and augmentation of diastolic filling. However, for the SCI group, the increase in vagal activity during the CFT was associated with no change in heart rate and an attenuation of diastolic function. Results from Study 4 showed that although individuals with SCI were hypovolemic, resting diastolic velocities were similar compared to the able-bodied group. This maintenance of diastolic function appeared to be attributed to the cardiac atrophy that manifests following SCI. In addition, there was no between-group difference in the diastolic response to rapid saline infusion. Findings from this dissertation suggest that the QTVI is a valid and reliable tool for non-invasively estimating cardiac autonomic regulation in individuals with SCI. In addition, although the mechanical aspect of diastolic function is preserved after SCI, atypical vagal-diastolic interactions may impair ventricular filling in this population.