Cardiac mechanics in patients with spinal cord injury and autonomic hyperreflexia

Background

Autonomic hyperreflexia (AHR) is common in patients with high-level spinal (above T6) cord injury (SCI). AHR is characterized by episodes of severe hypertension triggered by visceral or skin nociceptive stimuli below neurological level of injury. This syndrome can be life-threatening and may impact long-term cardiovascular health.

Aims

To describe and determine the prevalence of left ventricular (LV) and left atrial (LA) mechanical abnormalities in patients with SCI and AHR.

Materials and Methods

This retrospective study included patients referred to the echocardiography laboratory in Garches, France, between 2018 and 2025 for evaluation of AHR in the context of chronic SCI. LV and LA mechanics were assessed using two-dimensional speckle-tracking echocardiography.

Results

Thirty patients with chronic SCI and AHR were included (median age 54 years; 97% male; 54% AIS A [complete SCI]; cervical level lesion in 28/30 patients). One patient had a history of cerebral hemorrhage secondary to AHR.

Left ventricular systolic dysfunction, defined as LVEF <50%, was present in 3 patients (10%). Among patients with available 2D speckle-tracking imaging data (n=15), LA mechanics were abnormal in all patients (graph). Impaired left ventricular global longitudinal strain (LV GLS <−18%) was observed in 93% of patients.

All patients showed reduced LA reservoir and LA booster strain, with a median LA reservoir strain of 11% [6.5–12] and a median LA booster strain of 5% [4–6]. These abnormalities were also present in the three patients younger than 30 years without known cardiovascular disease.

Conclusion

Our findings suggest significant alterations in cardiac mechanics in patients with SCI and AHR, including in young individuals without traditional cardiovascular risk factors.LA reservoir strain ( SCI level C4 )