The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory...
Transcript of The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory...
![Page 1: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/1.jpg)
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
![Page 2: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/2.jpg)
Paolo NespoliEuropean Space Agency astronaut
![Page 3: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/3.jpg)
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)
![Page 4: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/4.jpg)
![Page 5: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/5.jpg)
CardiacOutput(Rebreathing)
![Page 6: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/6.jpg)
Cardiac outputby
rebreathingFreon
![Page 7: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/7.jpg)
BloodPressure(Brachial)
CardiacOutput(Rebreathing)
![Page 8: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/8.jpg)
BloodPressure(Brachial)
CardiacOutput(Rebreathing)
BloodSample(Catechol)
24-h urine(Vol, Na, K, Osm)
![Page 9: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/9.jpg)
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.
![Page 10: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/10.jpg)
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
![Page 11: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/11.jpg)
ResultsN = 8 males:
Age: 49 ± 1 yHeight: 181 ± 2 cm Weight: 85 ± 4 kg
![Page 12: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/12.jpg)
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
![Page 13: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/13.jpg)
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
![Page 14: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/14.jpg)
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)
![Page 15: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/15.jpg)
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
![Page 16: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/16.jpg)
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
![Page 17: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/17.jpg)
5
15
25
PRE FLIGHT POST
mm
Hg
· L-1
· min
TPR
* †
17±111±1
18±1
Systemic Vascular Resistance
![Page 18: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/18.jpg)
5
15
25
PRE FLIGHT POST
mm
Hg
· L-1
· min
TPR
* †
17±111±1
18±1
39 ± 4 % decrease
Systemic Vascular Resistance
![Page 19: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/19.jpg)
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
![Page 20: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/20.jpg)
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 %
![Page 21: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/21.jpg)
Future challenge (II):
To identify the spaceflight vasodilatation mechanism
BP
SNA
39 ± 4 %
![Page 22: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/22.jpg)
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)
![Page 23: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/23.jpg)
Thank you
Thank you!Norsk et al. J. Physiol. 593: 573-584, 2015.
![Page 24: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/24.jpg)
SVR SNA
BP
(+)
Arterial baro-receptors(+)
SpaceflightVasodilatationMechanism(s)?
![Page 25: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/25.jpg)
Myogenic,Vascular
Constriction
Headward fluid shift
1-G seated
0 G
Cardiac distension
Vasodilatory(Natriuretic)
Peptides
SVR SNA
BP
(+)
Arterial baro-receptors(+)
SpaceflightVasodilatationMechanism(s)?
![Page 26: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/26.jpg)
Myogenic,Vascular
Constriction
Headward fluid shift
1-G seated
0 G
Cardiac distension
Vasodilatory(Natriuretic)
Peptides
SVR SNA
BP
(+)
(-)
Arterial baro-receptors(+)
SpaceflightVasodilatationMechanism(s)?
![Page 27: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/27.jpg)
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)?
![Page 28: The CARD Experiment - NASA€¦ · The CARD Experiment: Fluid Shifts, Vasodilatation and Ambulatory Blood Pressure Reduction ... SAP (mm Hg) In-flight 60 70 80 90 100 110 120 DAP](https://reader031.fdocuments.in/reader031/viewer/2022041000/5ea0c5e3a371542c301ba9f3/html5/thumbnails/28.jpg)
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