Cardiovascular-Autonomic

 

Dr. Jill Wecht
Associate Professor of Medicine and Rehabilitation Medicine
Mount Sinai School of Medicine,
New York, NY
VA RR&D Research Health Science Specialist
(718) 584-9000 ext 3122
JM.Wecht@va.gov

Dr. Wecht’s association with the Spinal Cord Damage Research Center started as a volunteer while in graduate school at Columbia University. While pursuing her Doctorate of Education in Movement Science, she was in a class with Dr. Spungen. Dr. Wecht became interested in the Spinal Cord Damage Research Center after hearing Dr. Spungen lecture on her Doctoral research in persons with spinal cord injury. With an intense interest in the evolving knowledge and understanding of cardiovascular autonomic function in persons with varying levels of spinal cord injury, Dr. Wecht led the creation of the Cardiovascular Autonomic Program in the National Center of Excellence, and now serves as its Director. Dr. Wecht is an Associate Professor of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, and she has established scientific collaborations with investigators at the Kessler Institute for Rehabilitation, located in West Orange, New Jersey, where she is studying the impact of age on cardiovascular, cerebrovascular, and cognitive functions in persons with a spinal cord injury. Dr. Wecht is also a co-chairperson of the International Consortium of Clinicians and Scientists working together to develop International Standards to Document the Remaining Autonomic Function following spinal cord injury (http://www,ncbi.nlm.nih.gov/pubmed/22925746). Dr. Wecht is also a member of the International Spinal Cord Injury Metabolic and Endocrine Data Set, which is under the International Spinal Cord Society and the American Spinal Injury Association. The current research that Dr. Wecht is performing addresses the effects of sustained blood pressure elevation and age on cerebral blood flow and cognitive function. 

Program goals (Lay)
Both heart rate and blood pressure are controlled by a specialized group of nerves that is collectively referred to as the autonomic nervous system (or the “silent” nervous system). Higher spinal cord injuries (in the neck) interrupt nerves of the sympathetic nervous system (one branch of the autonomic nervous system) which connect to the heart and most of the body’s peripheral blood vessels.  The sympathetic nervous system is largely responsible for raising blood pressure and increasing heart rate. Individuals with high spinal cord injury generally have lower blood pressures and lower heart rates.  Dr. Wecht and her study team are actively studying the effects of low blood pressure on blood flow to the brain and its potential adverse effect on cognitive function in persons with spinal cord injury. Improving blood flow to the brain would be expected to result in increased quality of life for those with spinal cord injury. Importantly, Dr. Wecht, in collaboration with investigators at Kessler Institute for Rehabilitation, is investigating the effect of raising blood pressure on blood flow to the brain during thinking tasks using functional MRI brain imaging, which sensitively and accurately depicts blood flow to different areas of the brain. Following a lower spinal cord injury (lower back) it is believed that sympathetic control of the heart is functioning normally but that autonomic control of the blood vessels in the legs is not normal.  However, Dr. Wecht and her study team made the observation that heart rate was elevated in persons with lower spinal cord injuries, suggesting autonomic nervous system dysfunction of the heart.

Program goals (Scientific)
Dr. Wecht’s research focuses on the cardiovascular consequences of decentralized autonomic control.  It is generally accepted that individuals with SCI above the sixth thoracic vertebral level have chronic hypotension with periods of large, life threatening, increases in blood pressure due to autonomic dysreflexia.  Less well appreciated, however, is that regardless of the level of injury, vagal and sympathetic control of the heart rate is altered, which may have significant impact on cardiovascular health and longevity. Dr. Wecht and her study team are developing a battery of clinically useful tools for use in diagnosing the degree of autonomic cardiovascular impairment in persons with SCI (clinicaltrials.gov NCT01758692).  In addition, impairment of cardiovascular autonomic integrity may have adverse effects on cerebral blood flow, cognitive function and quality of life.  The study team is undertaking several investigations to document associations between cardiovascular, cerebrovascular, and cognitive function in persons with SCI (clinicaltrials.gov NCT02122991 & NCT01984476) and to determine if increases in systemic blood pressure improve cognitive performance and quality of life (clinicaltrials.gov NCT02307565).


 

Research

Relevant Publications

  1. 1.         Krassioukov A, Biering-Sorensen F, Donovan W, Kennelly M, Kirshblum S, Krogh K, et al. International standards to document remaining autonomic function after spinal cord injury. J Spinal Cord Med2012 Jul;35(4):201-10.
    http://www.ncbi.nlm.nih.gov/pubmed/22925746  
    2.         Wecht JM, Bauman WA. Decentralized cardiovascular autonomic control and cognitive deficits in persons with spinal cord injury. J Spinal Cord Med2013 Mar;36(2):74-81.
    http://www.ncbi.nlm.nih.gov/pubmed/3595971
    3.         Wecht JM, Radulovic M, Rosado-Rivera D, Zhang RL, LaFountaine MF, Bauman WA. Orthostatic effects of midodrine versus L-NAME on cerebral blood flow and the renin-angiotensin-aldosterone system in tetraplegia. Arch Phys Med Rehabil2011 Nov;92(11):1789-95.
    http://www.ncbi.nlm.nih.gov/pubmed/21762873
    4.         Wecht JM, Rosado-Rivera D, Jegede A, Cirnigliaro CM, Jensen MA, Kirshblum S, et al. Systemic and cerebral hemodynamics during cognitive testing. Clin Auton Res2012 Feb;22(1):25-33.
    http://www.ncbi.nlm.nih.gov/pubmed/21792728  
    5.         Wecht JM, Rosado-Rivera D, Weir JP, Ivan A, Yen C, Bauman WA. Hemodynamic effects of L-threo-3,4-dihydroxyphenylserine (Droxidopa) in hypotensive individuals with spinal cord injury. Arch Phys Med Rehabil2013 Oct;94(10):2006-12.
    http://www.ncbi.nlm.nih.gov/pubmed/23602882
    6.         Wecht JM, Weir JP, Galea M, Martinez S, Bauman WA. Prevalence of Abnormal Systemic Hemodynamics in Veterans With and Without Spinal Cord Injury. Arch Phys Med Rehabil2015 Feb 4.
    http://www.ncbi.nlm.nih.gov/pubmed/25660005  
    7.         Wecht JM, Cirnigliaro CM, Azarelo F, Bauman WA, Kirshblum SC. Orthostatic responses to anticholinesterase inhibition in spinal cord injury. Clin Auton Res2015 Jun;25(3):179-87.
    http://www.ncbi.nlm.nih.gov/pubmed/25916633