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At least 145 records · Page 8

Efficacy of anticoagulation in resolving left atrial and left atrial appendage thrombi: A transesophageal echocardiographic study

BACKGROUND: Transesophageal echocardiography (TEE) is the gold standard for evaluation of the left atrium and the left atrial appendage (LAA) for the presence of thrombi. Anticoagulation is conventionally used for patients with atrial fibrillation to prevent embolization of atrial thrombi. The mechanism of benefit and effectiveness of thrombi resolution with anticoagulation is not well defined. METHODS AND RESULTS: We used a TEE database of 9058 consecutive studies performed between January 1996 and November 1998 to identify all patients with thrombi reported in the left atrium and/or LAA. One hundred seventy-four patients with thrombi in the left atrial cavity (LAC) and LAA were identified (1.9% of transesophageal studies performed). The incidence of LAA thrombi was 6.6 times higher than LAC thrombi (151 vs 23, respectively). Almost all LAC thrombi were visualized on transthoracic echocardiography (90.5%). Mitral valve pathology was associated with LAC location of thrombi (P <.0001), whereas atrial fibrillation or flutter was present in most patients with LAA location of thrombi. Anticoagulation of 47 +/- 18 days was associated with thrombus resolution in 80.1% of the patients on follow-up TEE. Further anticoagulation resulted in limited additional benefit. CONCLUSIONS: LAC thrombi are rare and are usually associated with mitral valve pathology. Transthoracic echocardiography is effective in identifying these thrombi. LAA thrombi occur predominantly in patients with atrial fibrillation or flutter. Short-term anticoagulation achieves a high rate of resolution of LAA and LAC thrombi but does not obviate the need for follow-up TEE.

NASA Discipline Cardiopulmonary

Reactions of astronauts under weightless conditions

Experimental data show that weightlessness conditions lasting 5 days or more (18-25) do not produce significant disturbances in physical reactions of astronauts, with the exception of some singularities in functioning of the cardiovascular system: A reduction in heart rate and somewhat large fluctuations in the physiological indicators of cutaneogalvanic reactions.

Kasyan, I. I.

Issues of exploration: human health and wellbeing during a mission to Mars

Today, the tools are in our hands to enable us to travel away from our home planet and become citizens of the solar system. Even now, we are seriously beginning to develop the robust infrastructure that will make the 21st century the Century of Space Travel. But this bold step must be taken with due concern for the health, safety and wellbeing of future space explorers. Our long experience with space biomedical research convinces us that, if we are to deal effectively with the medical and biomedical issues of exploration, then dramatic and bold steps are also necessary in this field. We can no longer treat the human body as if it were composed of muscles, bones, heart and brain acting independently. Instead, we must lead the effort to develop a fully integrated view of the body, with all parts connected and fully interacting in a realistic way. This paper will present the status of current (2000) plans by the National Space Biomedical Research Institute to initiate research in this area of integrative physiology and medicine. Specifically, three example projects are discussed as potential stepping stones towards the ultimate goal of producing a digital human. These projects relate to developing a functional model of the human musculoskeletal system and the heart. c2002 COSPAR. Published by Elsevier Science Ltd. All rights reserved.

NASA Discipline General Space Life Sciences

Cardiovascular Session Summary

It was apparent that the bed-rest and spaceflight data indicated that decreases in plasma volume and cardiac atrophy along with cardiac remodeling were fundamental changes which predisposed many astronauts to post flight orthostatic intolerance. Despite the recently acquired in-flight and post-flight muscle sympathetic nerve activity findings suggesting that the sympathetic nerve responses were appropriate there remains significant contrary data from bed-rest studies, post- flight stand tests and hind-limb unweighted rat studies that suggest that the vasoconstrictive responses were compromised at least insufficient in susceptible individuals. The key issues raised is whether a diminished increase in sympathetic activity from baseline without changes in 254 First Biennial Space Biomedical Investigators'Workshop Cardiovascular peak response or receptor adaptations is an abnormal response or is an individual variance of response to the accentuated decrease in stroke volume. Data relating autonomic neural control of heart rate were presented to suggest that the vagal and sympathetic control of heart rate was attenuated. Also, bed-rest and space flight induced attenuated baroreflex control of heart rate was shown to be restored to pre-bedrest function by one bout of maximal dynamic exercise. However, these data were confounded by relying on the use of R-R interval as a measure of efferent responses of the baroreflex during a condition in which the baseline heart rate was changed. Clearly the idea that the autonomic control of heart rate may be changed by microgravity needs further investigation. This direction is suggested despite the fact that in the triple product (HR x SV x TPR = MAP) assessment of the regulation of arterial blood pressure during orthostasis the role of the HR reflex may be less influential than that associated. with cardiac atrophy (SV changes) and aberrant sympathetic vasoconstriction (resistance) changes. Although sympathetic nerve activity responses in-flight and post-flight on neurolab appeared appropriate, enough bed-rest and post-flight stand test data, along with animal model data suggest that vasoconstriction was compromised. The mechanism of this compromised vasoconstriction needs to be delineated. Other major findings concerning microgravity and physiological regulatory systems are that: I . Thermoregulatory adaptation appear to suggest some decrements in the control of cutaneous vasodilation and sweating; 2. Calcium resorption and dietary calcium need to be defined for differing durations of spaceflight, especially as the effects of excess calcium on vasomotor function appears to be detrimental; 3. Neurohumoral mechanisms of microgravity induced changes in neural function and the regulation of plasma volume and total body water, bone resorption and autonomic neural control of the circulation need further delineation; 4. As performance of work tasks become prolonged, the mechanisms of blood pressure regulation in microgravity needs to be used in the recovery period from prolonged work tasks.

Raven, Peter

Cardiovascular physiology - Effects of microgravity

Experiments during spaceflight and its groundbase analog, bedrest, provide consistent data which demonstrate that numerous changes in cardiovascular function occur as part of the physiological adaptation process to the microgravity environment. These include elevated heart rate and venous compliance, lowered blood volume, central venous pressure and stroke volume, and attenuated autonomic reflex functions. Although most of these adaptations are not functionally apparent during microgravity exposure, they manifest themselves during the return to the gravitational challenge of earth's terrestrial environment as orthostatic hypotension and instability, a condition which could compromise safety, health and productivity. Development and application of effective and efficient countermeasures such as saline "loading," intermittent venous pooling, pharmacological treatments, and exercise have become primary emphases of the space life sciences research effort with only limited success. Successful development of countermeasures will require knowledge of the physiological mechanisms underlying cardiovascular adaptation to microgravity which can be obtained only through controlled, parallel groundbased research to complement carefully designed flight experiments. Continued research will provide benefits for both space and clinical applications as well as enhance the basic understanding of cardiovascular homeostasis in humans.

Convertino, V.

Specialized physiological studies in support of manned space flight

The reversible changes that take place in the cardiovascular system during weightlessness were investigated. Particular attention was given to the assessment of cardiovascular functions during and after space missions. One of the most important of these functions is the amount of blood pumped by the heart per min at rest and during exercise of gravitational stress.

Luft, U. C.

Comparison of the Physiology of the Spaceflight and Hindlimb Suspended Rat

The suspended rat has been used extensively as a simulation of the spaceflight animal. In suspension, hindlimbs are unloaded from the acceleration of gravity, much as they are in spaceflight. Comparisons of data from spaceflight (microgravity) and suspended (1G) rats have suggested that suspension my be an appropriate model, but no direct comparisons had been made between the spaceflight and suspended rat. Cosmos 2044 afforded the first opportunity to directly compare the effects of hindlimb suspension (HS) and spaceflight (SF) on a broad range of physiological and histological parameters. This paper reports on the comparison of skelton, skeletal muscle, heart, neural, pulmonary, kidney, liver, intestine, blood plasma, immune function, red blood cells, and endocrine and reproductive functions and systems.

Grindeland, R. E.

Mathematical modelling of flow distribution in the human cardiovascular system

The paper presents a detailed model of the entire human cardiovascular system which aims to study the changes in flow distribution caused by external stimuli, changes in internal parameters, or other factors. The arterial-venous network is represented by 325 interconnected elastic segments. The mathematical description of each segment is based on equations of hydrodynamics and those of stress/strain relationships in elastic materials. Appropriate input functions provide for the pumping of blood by the heart through the system. The analysis employs the finite-element technique which can accommodate any prescribed boundary conditions. Values of model parameters are from available data on physical and rheological properties of blood and blood vessels. As a representative example, simulation results on changes in flow distribution with changes in the elastic properties of blood vessels are discussed. They indicate that the errors in the calculated overall flow rates are not significant even in the extreme case of arteries and veins behaving as rigid tubes.

NASA Center JSC

Assessment of autonomic response by broad-band respiration

We present a technique for introducing broad-band respiratory perturbations so that the response characteristics of the autonomic nervous system can be determined noninvasively over a wide range of physiologically relevant frequencies. A subject's respiratory bandwidth was broadened by breathing on cue to a sequence of audible tones spaced by Poisson intervals. The transfer function between the respiratory input and the resulting instantaneous heart rate was then computed using spectral analysis techniques. Results using this method are comparable to those found using traditional techniques, but are obtained with an economy of data collection.

NASA Discipline Cardiopulmonary

Using Concurrent Cardiovascular Information to Augment Survival Time Data from Orthostatic Tilt Tests

Orthostatic Intolerance (OI) is the propensity to develop symptoms of fainting during upright standing. OI is associated with changes in heart rate, blood pressure and other measures of cardiac function. Problem: NASA astronauts have shown increased susceptibility to OI on return from space missions. Current methods for counteracting OI in astronauts include fluid loading and the use of compression garments. Multivariate trajectory spread is greater as OI increases. Pairwise comparisons at the same time within subjects allows incorporation of pass/fail outcomes. Path length, convex hull area, and covariance matrix determinant do well as statistics to summarize this spread Missing data problems Time series analysis need many more time points per OTT session treatment of trend? how incorporate survival information?

Feiveson, Alan H.

Synchronization of Human Autonomic Nervous System Rhythms with Geomagnetic Activity in Human Subjects

A coupling between geomagnetic activity and the human nervous system's function was identified by virtue of continuous monitoring of heart rate variability (HRV) and the time-varying geomagnetic field over a 31-day period in a group of 10 individuals who went about their normal day-to-day lives. A time series correlation analysis identified a response of the group's autonomic nervous systems to various dynamic changes in the solar, cosmic ray, and ambient magnetic field. Correlation coefficients and p values were calculated between the HRV variables and environmental measures during three distinct time periods of environmental activity. There were significant correlations between the group's HRV and solar wind speed, Kp, Ap, solar radio flux, cosmic ray counts, Schumann resonance power, and the total variations in the magnetic field. In addition, the time series data were time synchronized and normalized, after which all circadian rhythms were removed. It was found that the participants' HRV rhythms synchronized across the 31-day period at a period of approximately 2.5 days, even though all participants were in separate locations. Overall, this suggests that daily autonomic nervous system activity not only responds to changes in solar and geomagnetic activity, but is synchronized with the time-varying magnetic fields associated with geomagnetic field-line resonances and Schumann resonances.

Magnetic Fields

Workshop on the Role of Design Assurance in System-Wide Safety’s Safety Demonstrator Series

This report summarizes a three-hour hybrid in-person/online workshop on June 7, 2024 on the topic of design assurance and the Safety Demonstrator Series (SDS), which was held at NASA Ames Research Center. The SDS provides an operational demonstration of, and recommendations for, requirements and standards necessary to monitor, assess, and mitigate risks to assure safety in disaster-oriented operations. Over sixty NASA personnel participated in the workshop. Four main topics were discussed: (1) assurance needs for the Safety Demonstrator Series, (2) assurance and the In-Time Aviation Safety Management System (IASMS), (3) in-time assurance: existing efforts and future opportunities, and (4) demonstrating assurance tools in the Safety Demonstrators. Key takeaways are as follows: 1. Design assurance tools can be used to assure an In-Time Aviation Safety Management System, the systems that comprise it, and other systems or missions. Assurance must consider both systems and components and include the interactions between elements in both a systems/aircraft context and a systems-of-systems/airspace context. 2. Design-time assurance activities can support the identification of monitors needed for operational assurance activities (i.e., the “monitor” function in the monitor-assess-mitigate paradigm at the heart of the IASMS concept). 3. A major opportunity for design-time assurance tools to contribute to the IASMS concept is to support rapid re-validation of systems. This will be particularly important for (1) supporting novel operations in the IASMS, where operational data may disprove design-time assumptions (motivating re-analysis of system safety) and (2) adapting technologies (e.g., AI/ML for autonomous operations) to new operational domains, where there may be new or different safety considerations not included in the initial scope of operations. 4. There are several design assurance tools under development in the System-Wide Safety project that can support assurance of Services, Functions, and Capabilities (SFCs) in the Safety Demonstrators. Transitioning these tools from one-off research projects into a functioning part of IASMS assurance will require closer integration between these tools. 5. It is not clear whether the role of design assurance tools is primarily as a part of IASMS architecture or as an external check on IASMS. The workshop consisted of four discussion topics initiated via four lightning talks by System-Wide Safety researchers. Discussions utilized Mural to engage both in-person and online participants in the hybrid format. Polls and surveys were also utilized to gather participant input. The workshop closed with a reflection activity for participants, as well as new ideas for collaboration and coordination of ongoing System-Wide Safety research.

design assurance

Pressor response to intravenous tyramine is a marker of cardiac, but not vascular, adrenergic function

Intravenous injections of the indirect sympathetic amine, tyramine, are used as a test of peripheral adrenergic function. The authors measured the time course of increases in ejection fraction, heart rate, systolic and diastolic pressure, popliteal artery flow, and greater saphenous vein diameter before and after an injection of 4.0 mg/m(2) body surface area of tyramine in normal human subjects. The tyramine caused moderate, significant increases in systolic pressure and significant decreases in total peripheral resistance. The earliest changes were a 30% increase in ejection fraction and a 16% increase in systolic pressure, followed by a 60% increase in popliteal artery flow and a later 11% increase in greater saphenous vein diameter. There were no changes in diastolic pressure or heart rate. These results suggest that pressor responses during tyramine injections are primarily due to an inotropic response that increases cardiac output and pressure and causes a reflex decrease in vascular resistance. Thus, tyramine pressor tests are a measure of cardiac, but not vascular, sympathetic function.

NASA Discipline Cardiopulmonary

The Effects of Autogenic Feedback Training Exercise on Heart Rate Variability

INTRODUCTION: The development of Motion Sickness (MS) symptoms is correlated with increased sympathetic influence and irregular patterns of vagal activity. Such autonomic actions can be characterized by indices of heart rate variability (HRV), which reflect autonomic balance through neurocardiac function. Nonpharmacological interventions aimed at attenuating MS symptoms may therefore produce an effect on HRV. One such intervention that has been shown to mitigate MS symptoms is Autogenic Feedback Training Exercise (AFTE), which combines principles of autogenic therapy and biofeedback. AFTE teaches individuals to manipulate various physiological parameters in provocative environments and shows promise as a potential MS intervention in military aviators. The effects of AFTE on HRV have not previously been examined. Understanding HRV changes following AFTE may help to elucidate its indirect effects and inform its implementation for MS mitigation. METHODS: Twenty-four subjects received 2 hours of AFTE over 4 days. Pre- and post-AFTE rotating chair tests, which included stationary periods of baseline data, were conducted to evaluate the effects of AFTE. HRV data were recorded by SOMNOtouch™ NIBP. Post hoc analysis of pre- and post-AFTE short-term HRV (RMSSD, LF, HF, LF/HF) was performed. RESULTS: RMSSD, HF, and LF/HF were not significantly changed following AFTE. However, LF showed a statistically significant (p=0.015) decrease following AFTE. DISCUSSION: AFTE prescribes a respiratory rate of 15 breaths per minute (BPM), which is typically faster than participants’ pre-AFTE BPM (M=12.65). Healthy individuals can increase respiratory sinus arrhythmia (RSA) by slow, deep breathing. However, increasing the respiratory rate to 15 BPM may decrease RSA and subsequently HF. Increasing RSA potentially negates any influence of AFTE on HF, resulting in no significant change. RMSSD is correlated with HF power and was likewise not affected by AFTE. LF power, however, decreased significantly following AFTE, potentially indicating a lower sympathetic response in the post-AFTE measurement.

motion sickness

Development of the NASA/Baylor VAD

A cooperative effort between the NASA/Johnson Space Center (JSC) and the Baylor College of Medicine (BCM) has been underway since 1988 to develop a long-term implantable Ventricular Assist Device (VAD). The VAD is intended to boost the cardiac output of patients with deteriorated cardiac function. For many of these patients, the best alternative is heart transplantation. Heart transplantation is a complex and expensive procedure and usually requires a long waiting period for a donor heart. The condition of the patient often deteriorates during this waiting period which complicates the pre and post-operative care. Because of these factors, the need for a long-term implantable VAD for use as a bridge-to-transplant device or as a permanent assist device has become the focus of much research. The need for a VAD has been estimated at 50,000 to 60,000 patients per year in the United States alone. A device which satisfies all the system performance and reliability requirements has yet to be achieved. However, the development of the NASA/Baylor VAD has progressed to a state in which commercial viability can being to be considered. The device is small, simple, efficient and reliable which meets all requirements for a totally implantable VAD.

Aber, G. S.

Mechanisms of blood pressure regulation that differ in men repeatedly exposed to high-G acceleration

The purpose of this study was to test the hypothesis that repeated exposure to high acceleration (G) would be associated with enhanced functions of specific mechanisms of blood pressure regulation. We measured heart rate (HR), stroke volume (SV), cardiac output (), mean arterial blood pressure, central venous pressure, forearm and leg vascular resistance, catecholamines, and changes in leg volume (%DeltaLV) during various protocols of lower body negative pressure (LBNP), carotid stimulation, and infusions of adrenoreceptor agonists in 10 males after three training sessions on different days over a period of 5-7 days using a human centrifuge (G trained). These responses were compared with the same measurements in 10 males who were matched for height, weight, and fitness but did not undergo G training (controls). Compared with the control group, G-trained subjects demonstrated greater R-R interval response to equal carotid baroreceptor stimulation (7.3 +/- 1.2 vs. 3.9 +/- 0.4 ms/mmHg, P = 0.02), less vasoconstriction to equal low-pressure baroreceptor stimulation (-1.4 +/- 0.2 vs. -2.6 +/- 0.3 U/mmHg, P = 0.01), and higher HR (-1.2 +/- 0.2 vs. -0.5 +/- 0.1 beats. min(-1). mmHg(-1), P = 0.01) and alpha-adrenoreceptor response (32.8 +/- 3.4 vs. 19.5 +/- 4.7 U/mmHg, P = 0.04) to equal dose of phenylephrine. During graded LBNP, G-trained subjects had less decline in and SV, %DeltaLV, and elevation in thoracic impedance. G-trained subjects also had greater total blood (6,497 +/- 496 vs. 5,438 +/- 228 ml, P = 0.07) and erythrocyte (3,110 +/- 364 vs. 2,310 +/- 96 ml, P = 0.06) volumes. These results support the hypothesis that exposure to repeated high G is associated with increased capacities of mechanisms that underlie blood pressure regulation.

Non-NASA Center

Aerobic Capacity Following Long Duration International Spaces Station (ISS) Missions: Preliminary Results

Maximum oxygen uptake (VO2max) is reduced immediately following space flights lasting <15 d, but has not been measured following long-duration missions. The purpose of this study is to measure VO2max and maximum work rate (WRmax) data from astronauts following ISS flights (91 to 188 d). Methods: Five astronauts [3 M, 2 F: 47+/-6 yr, 174+/-6 cm, 71.9+/-10.9 kg (mean +/- SD)] have participated in the study. Subjects performed upright cycle exercise tests to symptom-limited maximum. An initial test was done approx.270 d before flight to establish work rates for subsequent tests. Subsequent tests, conducted approx.45 d before flight and repeated on the first or second day (R+1/2) and at approx.10 d (R+10) following landing, consisted of 3 5 min stages designed to elicit 25%, 50%, and 75% of preflight VO2max, followed by 25 W(dot)/min increases. VO2, WR, and heart rate (HR) were measured using the ISS Portable Pulmonary Function System [Damec, Odense, DK]. Descriptive statistics are reported. Results: On R+1/2 mean VO2max decreased compared to preflight (Pre: 2.98+/-0.99, R+1/2: 2.63+/-0.56 L(dot)/min); 4 of 5 subjects demonstrated a loss of > 6%. WRmax also decreased on R+1/2 compared to preflight (Pre: 245+/-69, R+1/2: 210+/-45 W). On R+10, VO2max was 2.86+/-0.62 L(dot)/min, with 2 subjects still demonstrating a loss of > 6% from preflight. WRmax on R+10 was 240+/-49 W. HRmax did not change from pre to post-flight. Conclusions: These preliminary results, from the first 5 of 12 planned subjects of an ongoing ISS study, suggest that the majority of astronauts will experience a decrease in VO2max after long-duration space-flight. Interestingly, the two astronauts with the highest preflight VO2max had the greatest loss on R+1/2, and the astronaut with the lowest preflight VO2max increased by 13%. Thus, maintenance of VO2max may be more difficult in astronauts who have a high aerobic capacity, perhaps requiring more intense in-flight exercise countermeasure prescriptions.

Moore, Alan D.

Maximum Oxygen Uptake During Long-Duration Space Flight: Preliminary Results

INTRODUCTION: Maximum oxygen uptake (VO2max) is maintained during space flight lasting <15 d, but has not been measured during long-duration missions. This abstract describes pre-flight and in-flight preliminary findings from the International Space Station (ISS) VO2max experiment. METHODS: Seven astronauts (4 M, 3 F: 47 +/- 5 yr, 174 +/- 7 cm, 74.1 +/- 14.7 kg [mean +/- SD]) performed cycle exercise tests to volitional maximum approx.45 d before flight and tests were scheduled every 30 d during flight beginning on flight day (FD) 14. Tests consisted of three 5-min stages designed to elicit 25%, 50%, and 75% of preflight VO2max, followed by 25 W/min increases. VO2 and heart rate (HR) were measured using the ISS Portable Pulmonary Function System (PPFS) (Damec, Odense, DK). Unfortunately the PPFS did not arrive at the ISS in time to support early test sessions for 3 crewmembers. Descriptive statistics are presented for pre-flight vs. late-flight (FD 147 +/- 33 d) comparisons for all subjects (n=7); and pre-flight, early (FD 18 +/- 3) and late-flight (FD 156 +/- 5) data are presented for subjects (n=4) who completed all of these test sessions. RESULTS: When all subjects are considered, average VO2max decreased from pre- to late in-flight (2.98 +/- 0.85 vs. 2.57 +/- 0.50 L/min) while maximum HR late-flight seemed unchanged (178 +/- 9 vs. 175 +/- 8 beats/min). Similarly, for subjects who completed pre-, early, and late flight measurements (n=4), mean VO2max declined from 3.19 +/- 0.75 L/min preflight to 2.43 +/- 0.43 and 2.62 +/- 0.38 L/min early and late-flight, respectively. Maximum HR was 183 +/- 8, 174 +/- 8, and 179 +/- 6 beats/min pre-, early- and late-flight. DISCUSSION: Average VO2max declined during flight and did not appreciably recover as flight duration increased; however much inter-subject variation occurred in these changes.

Moore, A. D., Jr.