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The CARD Experiment:

Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reductionduring Long Duration Spaceflight

1,2Peter Norsk, 2,3Ali Asmar, 4Morten Damgaard and 5Niels Juel Christensen

1USRA/NASA, Johnson Space Center, Houston, Texas, USA;2Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark;3Department of Clinical Physiology & Nuclear Medicine, Bispebjerg University Hospital, Copenhagen, Denmark;4Department of Clinical Physiology & Nuclear Medicine, Koege Hospital, Koege, Denmark;5Department of Internal Medicine and Endocrinology, Herlev University Hospital, Herlev, Denmark.

https://ntrs.nasa.gov/search.jsp?R=20150011045 2020-04-22T22:31:37+00:00Z

Paolo NespoliEuropean Space Agency astronaut

PurposeTo investigate how fluid shifts, blood pressure and systemic vascular resistance adapt to long duration (3-6 months) spaceflight.

Based on results from one week into a shuttle mission(Norsk et al., Hypertension, 47: 69-73,2006)

CardiacOutput(Rebreathing)

Cardiac outputby

rebreathingFreon

BloodPressure(Brachial)

CardiacOutput(Rebreathing)

BloodPressure(Brachial)

CardiacOutput(Rebreathing)

BloodSample(Catechol)

24-h urine(Vol, Na, K, Osm)

Experimental protocolPre-flight: Launch minus 322 – 71 daysIn-flight: Launch plus 85 – 192 days in-flightPost-flight: Landing plus 58 – 209 days_____________________________________________________________________

Time: 12:00 16:00 20:00 24:00 04:00 08:00 12:0014:00 18:00 22:00 02:00 06:00 10:00

_____________________________________________________________________

Blood pressure: X X X X X X X X X X X X X X X X X X X X(Ambulatory)

Cardiac output: X X X X X(Seated)

Blood sampling: X(Seated)

Urine collection: >-----------------------------------------------------------------------< (ambulatory)______________________________________________________________________X: Execution.

Experimental protocolPre-flight: Launch minus 322 – 71 daysIn-flight: Launch plus 85 – 192 days in-flightPost-flight: Landing plus 58 – 209 days_____________________________________________________________________

Time: 12:00 16:00 20:00 24:00 04:00 08:00 12:0014:00 18:00 22:00 02:00 06:00 10:00

_____________________________________________________________________

Blood pressure: X X X X X X X X X X X X X X X X X X X X(Ambulatory)

Cardiac output: X X X X X(Seated)

Blood sampling: X(Seated)

Urine collection: >-----------------------------------------------------------------------< (ambulatory)______________________________________________________________________X: Execution

ResultsN = 8 males:

Age: 49 ± 1 yHeight: 181 ± 2 cm Weight: 85 ± 4 kg

Stroke volume

70

110

150

190

PRE FLIGHT POST

ml

SV

* †

Cardiac output

4

6

8

10

PRE FLIGHT POST

L/m

in

CO

* †

100±6

133±8

92±4

6.2±0.4

8.4±0.3

6.1±0.3

Fluid Shifts

Stroke volume

70

110

150

190

PRE FLIGHT POST

ml

SV

* †

Cardiac output

4

6

8

10

PRE FLIGHT POST

L/m

in

CO

* †

100±6

133±8

92±4

6.2±0.4

8.4±0.3

6.1±0.3

35 ± 10% increase

41 ± 9 % increase

Fluid Shifts

90

100

110

120

130

140

150Pre-flightPost-flightIn-flight

SAP

(mm

Hg)

60

70

80

90

100

110

120

DA

P (m

m H

g)

12 14 16 18 20 22 00 02 04 06 08 10

70

80

90

100

110

120

130

Time (h)

MA

P (m

m H

g)

Blood Pressure(24-h ambulatory brachial)

90

100

110

120

130

140

150Pre-flightPost-flightIn-flight

SAP

(mm

Hg)

60

70

80

90

100

110

120

DA

P (m

m H

g)

12 14 16 18 20 22 00 02 04 06 08 10

70

80

90

100

110

120

130

Time (h)

MA

P (m

m H

g)

Blood Pressure(24-h ambulatory brachial)

Space

Ground

90

100

110

120

130

140

150Pre-flightPost-flightIn-flight

SAP

(mm

Hg)

60

70

80

90

100

110

120

DA

P (m

m H

g)

12 14 16 18 20 22 00 02 04 06 08 10

70

80

90

100

110

120

130

Time (h)

MA

P (m

m H

g)

Blood Pressure(24-h ambulatory brachial)

Space

Ground

• 10 mm Hg decrease

• No change in heart rate

• Nightly dip maintained

5

15

25

PRE FLIGHT POST

mm

Hg

· L-1

· min

TPR

* †

17±111±1

18±1

Systemic Vascular Resistance

5

15

25

PRE FLIGHT POST

mm

Hg

· L-1

· min

TPR

* †

17±111±1

18±1

39 ± 4 % decrease

Systemic Vascular Resistance

5

15

25

PRE FLIGHT POST

mm

Hg

· L-1

· min

TPR

* †

17±111±1

18±1

Plasma noradrenaline (ng/l):730 ± 130 720 ± 90 730 ± 100

39 ± 4 % decrease

Systemic Vascular Resistance

Future challenge (I):

To relate stroke volume and cardiac output to VIIP!

70

110

150

190

PRE FLIGHT POST

ml

SV

* †

4

6

8

10

PRE FLIGHT POST

L/m

in

CO

* †

35 ± 10 %

41 ± 9 %

Future challenge (II):

To identify the spaceflight vasodilatation mechanism

BP

SNA

39 ± 4 %

Acknowledgements: Co-authors

Niels J. Christensen (Herlev Univ. Hosp., Herlev, Denmark)Ali Asmar (Bispebjerg Univ. Hosp., CPH, Denmark)Morten Damgaard (Koege Hosp., Koege, Denmark).

Laboratory technical assistance

Jakob Utzon-Frank (Univ. CPH, Denmark)Inge H. Petersen (Univ. CPH, Denmark)

ESA assistance

Poul Knudsen (Danish Aerospace Company, Odense, Denmark)Thomas A. E. Andersen (Danish Aerospace Company, Odense, Denmark)

Allain Maillet (Cadmos, CNES, Toulouse France)Stephanie Herr (Cadmos, CNES, Toulouse, France)

Simone Thomas (ESA-ESTEC)Jennifer Ngo-Anh (ESA-ESTEC)Patrik Sundblad (ESA-ESTEC)Astronauts (ESA-EAC)

NASA assistance

Suzanne McCollum and Kathleen McMonigal (NASA-JSC)Astronauts (NASA-JSC)

Thank you

Thank you!Norsk et al. J. Physiol. 593: 573-584, 2015.

SVR SNA

BP

(+)

Arterial baro-receptors(+)

SpaceflightVasodilatationMechanism(s)?

Myogenic,Vascular

Constriction

Headward fluid shift

1-G seated

0 G

Cardiac distension

Vasodilatory(Natriuretic)

Peptides

SVR SNA

BP

(+)

Arterial baro-receptors(+)

SpaceflightVasodilatationMechanism(s)?

Myogenic,Vascular

Constriction

Headward fluid shift

1-G seated

0 G

Cardiac distension

Vasodilatory(Natriuretic)

Peptides

SVR SNA

BP

(+)

(-)

Arterial baro-receptors(+)

SpaceflightVasodilatationMechanism(s)?

Myogenic,Vascular

Constriction

CNS effects:•Vestibular disturbance•Intracranial pressure•Operational stress

Headward fluid shift

1-G seated

0 G

Cardiac distension

Vasodilatory(Natriuretic)

Peptides

SVR SNA

BP

(+)

(+)(-)

Arterial baro-receptors(+)

SpaceflightVasodilatationMechanism(s)?

Myogenic,Vascular

Constriction

CNS effects:•Vestibular disturbance•Intracranial pressure•Operational stress

Headward fluid shift

1-G seated

0 G

Cardiac distension

Vasodilatory(Natriuretic)

Peptides

SVR SNA

BP

(+)

(+)(-)

Arterial baro-receptors(+)

SpaceflightVasodilatationMechanism(s)?

CO2