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Désadaptations cardiovasculaires à la microgravité : techniques avancées pour améliorer la mesure et l'évaluation du risque cardiovaculaire induit par les vols spatiaux pour les équipages de longue durée

Abstract : Objective: to evaluate functional myocardial contractility after 21 days of head-down bed rest (HDTBR) in sedentary control (CON) or with a resistive vibration exercise (RVE) countermeasure (CM) applied, by using 4D echocardiographic (4D Echo) imaging and speckle tracking strain quantification.Methods: Twelve volunteers were enrolled in a crossover HDTBR design, and 4D Echo was performed in supine position (REST) at BDC-2 and at R+2, and in -6° HDTBR (on day 18), and also during the first and the last minute of the 80° head-up step of Standard Measures tilt test, performed at both BDC-2 and R+2. Radial (Rad-Str), longitudinal (Lg-Str) and twist (Tw-Str) strain were measured by 4D speckle tracking, as well as left ventricle diastolic volume (LVDV) and mass (LVmass).Results: On day 18: in the CON group, LVDV and LVmass were reduced (p<0.05), the Rad-Str decreased (p<0.05) and Tw-Str showed a tendency to increase (p< 0.11), with no changes in Lg-Str. In RVE group, LVDV and LV mass, as well as all the strain parameters remained unchanged.On R+2: in the CON group, LVDV and LVmass were not recovered in all subjects compared to pre-HDTBR (p<0.08), Rad-Str was still decreased (p<0.05), while Tw-Str tended to increase (p<0.09). These parameters remained unchanged in the RVE group.Tilt 80°: Rad-Str and Lg-Str values at 80° tilt were similar post HDT in both groups.Conclusion: 4D Echo and speckle tracking analysis showed that in the CON group, Rad-Str decreased concomitant with LVmass and LVDV with HDTBR, but this observation did not support the hypothesis that this HDTBR induced remodelling or a muscle atrophy. RVE acted to preserve both LVmass, LVDV and contractility during HDTBR, thus proving its effectiveness to this aim. Nevertheless, the significant HDTBR-induced changes observed in the CON group had only a limited effect on the cardiac contractile response as observed during post HDTBR tilt test. The level of contractility at 80° Tilt position was not affected neither by HDTBR nor by RVE CM.Purpose: The objective was to quantify the venous redistribution during a 4-day dry immersion (DI) and evaluate the effect of thigh cuffs.Methods: The study included 9 control (Co) and 9 subjects wearing thigh cuffs during daytime hours (CU). Ultrasound images were collected Pre DI, on the fourth day in the morning (D4 AM) and on the fourth day in the afternoon (D4 PM), to assess the following outcome variables: left ventricle dimension, stroke volume, and ejection fraction (LVD, SV, EF), jugular vein volume (JV), portal vein dimension (PV), middle cerebral vein velocity (MCVv). An additional measure of JV dimension was performed on the first day after having worn the cuffs for two hours (D1 2H).Results: The JV volume increased significantly from Pre to D1 2H in both groups, but increased more in the Co compare to the CU subjects (Co: 0,27+/0.15cm3 to 0.94+/-0;22 cm3;P<0.01 CU: 0,32+/-0.13 cm3 to 0.64+/-0.32 cm3 P<0.042).At D4 AM no difference was found between the two treatment groups for any of the parameters listed above.Stroke volume and EF decreased from Pre (SV:111+/-23cm3 to 93+/-24 cm3 p<0.05; EF:0.66+/-0.07 to 0.62+/-0.07 p<0.05). JV volume was slightly, but significantly increased (Co: 0.47+/-0.22cm3 CU:0.35+/-014cm3 P<0.05), while MCVv and PV remained unchanged from Pre DI. From D4 AM to PM these parameters did not show any significant change.Conclusion: The results confirm that DI induces, during the first 2-3 h, a significant cephalic fluid shift as observed in spaceflight. During this early phase the thigh cuffs reduced the amplitude of the fluid shift towards the head, but after 4 days in DI there was only a slight memory (residual) effect of DI on the jugular volume and no residual effect of thigh cuffs.
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Danielle Kathleen Wannamaker. Désadaptations cardiovasculaires à la microgravité : techniques avancées pour améliorer la mesure et l'évaluation du risque cardiovaculaire induit par les vols spatiaux pour les équipages de longue durée. Médecine humaine et pathologie. Normandie Université, 2019. Français. ⟨NNT : 2019NORMC433⟩. ⟨tel-02613475⟩

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