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Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury
Chronic high-thoracic and cervical spinal cord injury (SCI) results in a complex phenotype of cardiovascular consequences, including impaired left ventricular (LV) contractility. Here, we aim to determine whether such dysfunction manifests immediately post-injury, and if so, whether correcting impai...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562705/ https://www.ncbi.nlm.nih.gov/pubmed/33060602 http://dx.doi.org/10.1038/s41467-020-18905-8 |
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author | Williams, Alexandra M. Manouchehri, Neda Erskine, Erin Tauh, Keerit So, Kitty Shortt, Katelyn Webster, Megan Fisk, Shera Billingsley, Avril Munro, Alex Tigchelaar, Seth Streijger, Femke Kim, Kyoung-Tae Kwon, Brian K. West, Christopher R. |
author_facet | Williams, Alexandra M. Manouchehri, Neda Erskine, Erin Tauh, Keerit So, Kitty Shortt, Katelyn Webster, Megan Fisk, Shera Billingsley, Avril Munro, Alex Tigchelaar, Seth Streijger, Femke Kim, Kyoung-Tae Kwon, Brian K. West, Christopher R. |
author_sort | Williams, Alexandra M. |
collection | PubMed |
description | Chronic high-thoracic and cervical spinal cord injury (SCI) results in a complex phenotype of cardiovascular consequences, including impaired left ventricular (LV) contractility. Here, we aim to determine whether such dysfunction manifests immediately post-injury, and if so, whether correcting impaired contractility can improve spinal cord oxygenation (SCO(2)), blood flow (SCBF) and metabolism. Using a porcine model of T2 SCI, we assess LV end-systolic elastance (contractility) via invasive pressure-volume catheterization, monitor intraparenchymal SCO(2) and SCBF with fiberoptic oxygen sensors and laser-Doppler flowmetry, respectively, and quantify spinal cord metabolites with microdialysis. We demonstrate that high-thoracic SCI acutely impairs cardiac contractility and substantially reduces SCO(2) and SCBF within the first hours post-injury. Utilizing the same model, we next show that augmenting LV contractility with the β-agonist dobutamine increases SCO(2) and SCBF more effectively than vasopressor therapy, whilst also mitigating increased anaerobic metabolism and hemorrhage in the injured cord. Finally, in pigs with T2 SCI survived for 12 weeks post-injury, we confirm that acute hemodynamic management with dobutamine appears to preserve cardiac function and improve hemodynamic outcomes in the chronic setting. Our data support that cardio-centric hemodynamic management represents an advantageous alternative to the current clinical standard of vasopressor therapy for acute traumatic SCI. |
format | Online Article Text |
id | pubmed-7562705 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-75627052020-10-19 Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury Williams, Alexandra M. Manouchehri, Neda Erskine, Erin Tauh, Keerit So, Kitty Shortt, Katelyn Webster, Megan Fisk, Shera Billingsley, Avril Munro, Alex Tigchelaar, Seth Streijger, Femke Kim, Kyoung-Tae Kwon, Brian K. West, Christopher R. Nat Commun Article Chronic high-thoracic and cervical spinal cord injury (SCI) results in a complex phenotype of cardiovascular consequences, including impaired left ventricular (LV) contractility. Here, we aim to determine whether such dysfunction manifests immediately post-injury, and if so, whether correcting impaired contractility can improve spinal cord oxygenation (SCO(2)), blood flow (SCBF) and metabolism. Using a porcine model of T2 SCI, we assess LV end-systolic elastance (contractility) via invasive pressure-volume catheterization, monitor intraparenchymal SCO(2) and SCBF with fiberoptic oxygen sensors and laser-Doppler flowmetry, respectively, and quantify spinal cord metabolites with microdialysis. We demonstrate that high-thoracic SCI acutely impairs cardiac contractility and substantially reduces SCO(2) and SCBF within the first hours post-injury. Utilizing the same model, we next show that augmenting LV contractility with the β-agonist dobutamine increases SCO(2) and SCBF more effectively than vasopressor therapy, whilst also mitigating increased anaerobic metabolism and hemorrhage in the injured cord. Finally, in pigs with T2 SCI survived for 12 weeks post-injury, we confirm that acute hemodynamic management with dobutamine appears to preserve cardiac function and improve hemodynamic outcomes in the chronic setting. Our data support that cardio-centric hemodynamic management represents an advantageous alternative to the current clinical standard of vasopressor therapy for acute traumatic SCI. Nature Publishing Group UK 2020-10-15 /pmc/articles/PMC7562705/ /pubmed/33060602 http://dx.doi.org/10.1038/s41467-020-18905-8 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Williams, Alexandra M. Manouchehri, Neda Erskine, Erin Tauh, Keerit So, Kitty Shortt, Katelyn Webster, Megan Fisk, Shera Billingsley, Avril Munro, Alex Tigchelaar, Seth Streijger, Femke Kim, Kyoung-Tae Kwon, Brian K. West, Christopher R. Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury |
title | Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury |
title_full | Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury |
title_fullStr | Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury |
title_full_unstemmed | Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury |
title_short | Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury |
title_sort | cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562705/ https://www.ncbi.nlm.nih.gov/pubmed/33060602 http://dx.doi.org/10.1038/s41467-020-18905-8 |
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