European Journal of Applied Physiology

, Volume 119, Issue 11–12, pp 2435–2447 | Cite as

Modulation of left ventricular diastolic filling during exercise in persons with cervical motor incomplete spinal cord injury

  • Monira I. Aldhahi
  • Andrew A. Guccione
  • Lisa M. K. Chin
  • Joshua Woolstenhulme
  • Randall E. KeyserEmail author
Original Article



To characterize left ventricular diastolic function during an exertional challenge in adults with incomplete cervical spinal cord Injury (icSCI).


In this cross-sectional study, a two-group convenience sample was used to compare left ventricular LV diastolic performance during a 5–10 W·min−1 incremental arm ergometer exercise protocol, using bioimpedance cardiography. Subjects were eight males with cervical incomplete spinal cord injury (icSCI; C5-C7: age 39 ± 14 years) versus eight able-bodied males (CON: age 38 ± 13 years). Left ventricular (LV) diastolic indices included end-diastolic volume (EDV) and early diastolic filling ratio (EDFR). LV ejection time (LVET), inotropic index (dZ/dT2) and stroke volume (SV) were compared between the groups at peak exercise, and maximum workload for the icSCI group (isomax).


EDV (at peak exercise:131.4 ± 7.3 vs 188.78 ± 9.4, p < 0.001; at isomax: 131.4 ± 7.3 vs 169 ± 23, p = 0.0009) and EDFR (at peak exercise 73 ± 14% vs 119 ± 11%, p = 0.006; at isomax 94 ± 10; p = 0.009) were significantly reduced in icSCI compared to CON, respectively. Significant differences in LVET (icSCI: 273 ± 48 vs CON: 305 ± 68; p = 0.1) and dZ/dT2 (icSCI: 0.64 ± 0.11 vs CON: 0.85 ± 0.31; p = 0.1) were not observed at isomax, despite a significant decrease in SV in the subjects with icSCI (77.1 ± 6.05 mL vs 105.8 ± 9.2 mL, p < 0.00)


Left ventricular filling was impaired in the subjects with icSCI as evidenced at both peak exercise and isomax. It is likely that restrictions on the skeletal muscle pump mechanized the impairment but increased left ventricular wall stiffness could not be excluded as a mediator.


Diastolic function Exercise Spinal cord injury Stroke volume Cardiac preload Cardiac filling ratio 



American spinal injury impairment scale


Arm ergometer cardiopulmonary exercise test


Analysis of covariance


Cardiac inotropic index


Early diastolic filling ratio


End diastolic volume


Ejection fraction


Incomplete spinal cord injury


International physical activity questionnaire


Peak workload obtained by icSCI


Left ventricular ejection time


Mean arterial pressure


Maximal voluntary expiratory pressures


Maximal voluntary inspiratory pressures


Cardiac output


Systolic time ratio


Systemic vascular resistance


Stroke volume


Time of injury


Maximal oxygen uptake


Work rate


Bioelectrical impedance cardiography



The authors wish to acknowledge all the doctoral students of Department of Rehabilitation Science at George Mason University who assisted in conducting the study. The authors would like to thank Dr. John Collins for assisting in the statistical analysis.

Author contributions

All the authors contributed substantially to the manuscript. Contribution to the conception and design of the work (MA, RK, AG and LC). Conducted experiments, acquired the data and recruitment (MA, RK, AG). Conceived and analyzed data (all authors). Drafting the manuscript (MA, RK). RK served as the senior and supervising author and provided oversight of all aspects of manuscript Preparation. All authors reviewed the manuscript for important intellectual content and have approved it.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation ScienceGeorge Mason UniversityFairfaxUSA
  2. 2.Department of Rehabilitation Sciences, College of Health and Rehabilitation SciencesPrincess Nourah Bint Abdulrahman UniversityRiyadhKingdom of Saudi Arabia
  3. 3.Rehabilitation Medicine DepartmentNational Institutes of HealthBethesdaUSA
  4. 4.Gerorge Washington UniversityWashingtonUSA

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