Right ventricular tissue Doppler assessment in space during circulating volume modification using the Braslet device

Introduction: This joint US–Russian work aims to establish a methodology for assessing cardiac function in microgravity in association with manipulation of central circulating volume. Russian Braslet-M (Braslet) occlusion cuffs were used to temporarily increase the volume of blood in the lower extremities, effectively reducing the volume in central circulation. The methodology was tested at the International Space Station (ISS) to assess the volume status of crewmembers by evaluating the responses to application and release of the cuffs, as well as to modified Valsalva and Mueller maneuvers. This case study examines the use of tissue Doppler (TD) of the right ventricular (RV) free wall. Results: Baseline TD of the RV free wall without Braslet showed early diastolic E′ (16 cm/s), late diastolic A′ (14 cm/s), and systolic S′ (12 cm/s) velocities comparable with those in normal subjects on Earth. Braslet application caused 50% decrease of E′ (8 cm/s), 45% increase of A′, and no change to S′. Approximately 8 beats after the Braslet release, TD showed E′ of 8 cm/s, A′ of 12 cm/s, and S′ of 13 cm/s. At this point after release, E′ did not recover to baseline values while l A′ and S′ did recover. The pre-systolic cross-sectional area of the internal jugular vein without Braslet was 1.07 cm2, and 1.13 cm2 10 min after the Braslet was applied. The respective cross-sectional areas of the femoral vein were 0.50 and 0.54 cm2. The RV myocardial performance Tei index was calculated by dividing the sum of the isovolumic contraction time and isovolumic relaxation time by the ejection time ((IVCT+IVRT)/ET); baseline and Braslet-on values for Tei index were 0.25 and 0.22, respectively. Braslet Tei indices are within normal ranges found in healthy terrestrial subjects and temporarily become greater than 0.4 during the dynamic Braslet release portion of the study. Conclusions: TD modality was successfully implemented in space flight for the first time. TD of RV revealed that the Braslet influenced cardiac preload and that fluid was sequestered in the lower extremity interstitial and vascular space after only 10 min of application. This report demonstrates that Braslet application has an effect on RV physiology in long-duration space flight based on TD, and that this effect is in part due to venous hemodynamics.