Menu

 

The NASA Task Book
Advanced Search     

Project Title:  Coronary Anatomy and Physiology During 1 Year in Space Reduce
Images: icon  Fiscal Year: FY 2025 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 04/20/2020  
End Date: 04/19/2034  
Task Last Updated: 02/21/2025 
Download Task Book report in PDF pdf

Open Science: HRP Poster 2025.ppt 2,329 KB
Principal Investigator/Affiliation:   Levine, Benjamin D M.D. / The University of Texas Southwestern Medical Center at Dallas 
Address:  Institute for Exercise and Environmental Medicine (IEEM) 
7232 Greenville Ave, Suite 435 
Dallas , TX 75231-5129 
Email: benjaminlevine@texashealth.org 
Phone: 214-345-4619  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: The University of Texas Southwestern Medical Center at Dallas 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bungo, Michael  M.D. University of Texas Health Science Center at Houston 
Lindner, Jonathan R. M.D. University of Virginia Medical Center 
Key Personnel Changes / Previous PI: PI Benjamin D. Levine, MD ; CoI Michael W. Bungo, MD ; CoI Jonathan R. Lindner, MD [Note Linda Loerch is no longer CoI];
Project Information: Grant/Contract No. 80NSSC20K0987 
Responsible Center: NASA JSC 
Grant Monitor: Brocato, Becky  
Center Contact:  
becky.brocato@nasa.gov 
Unique ID: 13900 
Solicitation / Funding Source: 2019 HERO 80JSC018N0001-HHCHFBP: Human Health Countermeasures, Human Factors, Behavioral Performance. Appendix D 
Grant/Contract No.: 80NSSC20K0987 
Project Type: Flight 
Flight Program:  
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Cardiovascular:Risk of Cardiovascular Adaptations Contributing to Adverse Mission Performance and Health Outcomes
Human Research Program Gaps: (1) CV-101:Determine whether long-duration weightlessness and/or reduced gravity induces cardiovascular structural and functional adaptations that contribute to an increased risk of a cardiovascular event or and disease.
(2) CV-102:Determine whether space radiation induces cardiovascular structural and functional adaptations and/or oxidative stress and damage (OSaD)/inflammation that contribute to an increased risk of a cardiovascular event or and disease.
Flight Assignment/Project Notes: NOTE: End date is now 4/19/2034 per HHC element and NSSC information (Ed., 6/21/21)

Task Description: Since the majority of experienced astronauts are middle aged, they are at risk for developing serious cardiovascular events such as a myocardial infarction or sudden cardiac death, especially during high intensity exertion. Studies led to the current flight medicine practice of screening all astronaut candidates (and following all active crew members) with coronary artery calcium (CAC) scoring. However, atherosclerosis is a progressive process. The development of vascular calcification may be preceded by substantial non-calcified plaque, which may be most prone to rupture and cause an acute coronary syndrome. Radiation and inflammation may exacerbate this natural history. Coronary atherosclerosis impairs coronary endothelial function which can then both initiate and stimulate progression of atherosclerosis. Recent flight studies have suggested that non-coronary vascular beds may stiffen with reduced vascular reserve during 6-month International Space Station (ISS) missions, and ground-based studies have identified the surprising capacity for coronary atherosclerosis to evolve rapidly under extreme stress. In addition, the Principal Investigator (PI) team recently completed the Integrated CardioVascular (ICV) study that demonstrated: a) although cardiac arrhythmias did not increase in space in most astronauts, unexpectedly, left atrial (LA) size increased out of proportion to the changes in left ventricular (LV) size; and b) there was a subset of crew (1/13 or 8%) who had substantial increases in both ventricular and atrial arrhythmias. These data raise the specter of increased risk for atrial fibrillation (AF), the most common arrhythmia in the US which occurs a decade earlier in astronauts than in the general population. We speculate that the combination of spaceflight plus exercise countermeasures could magnify LA dilation and lead to AF during a 2-3 yr Mars mission. AF in astronauts is a particular concern with prolonged spaceflight because of limited access to care and the risk of impaired exercise performance, poorly controlled ventricular response, deterioration of ventricular function, and arterial emboli (including stroke).

Research Impact/Earth Benefits: Learning more about the natural progression of atherosclerosis in the spaceflight environment may have "spin-off" benefits for characterizing these processes in terrestrial populations. In addition, out exploratory aim in this project is to determine if a blood biomarker panel might be predictive of alterations in the atherosclerotic process. Should this prove useful, the direct benefit to clinical care on Earth would be significant.

Task Progress & Bibliography Information FY2025 
Task Progress: Experiments designed to accomplish these goals continue as crewmembers volunteer, are assigned a flight, and complete the proposed studies. It is too early to generate meaningful conclusions. However, the team has met, reviewed all completed imaging studies, and are happy with the data quality and results. We continue to recruit new crewmembers to volunteer for our CIPHER experiments as crews are identified and Informed Consent Briefings (ICBs) are scheduled. [Ed. Note: CIPHER is the short title for a set of 14 studies sponsored by NASA and international partner agencies ( https://www.nasa.gov/feature/experiments-to-unlock-how-human-bodies-react-to-long-space-journeys ). CIPHER stands for "Complement of Integrated Protocols for Human Exploration Research".] Two subjects have completed pre-flight studies and will fly during the next reporting period. Two other subjects will undergo pre-flight studies in the next year, and one will complete their 1-year follow up studies. All data are analyzed immediately, checked for quality, and periodically reviewed by the entire team.

Bibliography: Description: (Last Updated: 05/20/2025) 

Show Cumulative Bibliography
 
Articles in Peer-reviewed Journals MacNamara JP, Hearon CM, Manferdelli G, Shah AM, Tayon KG, Pandey A, Satyam S, Levine BD. "Heart failure in zero gravity-external constraint and cardiac hemodynamics." JAMA Cardiol. 2025 Jan 1;10(1):98-100. http://dx.doi.org/10.1001/jamacardio.2024.4596 ; PMID: 39549275; PMCID: PMC11569412. , Jan-2025
Articles in Peer-reviewed Journals Hedge ET, Brazile TL, Hughson RL, Levine BD. "Plasticity of the heart in response to changes in physical activity." J Physiol. 2024 Aug 20. Epub ahead of print. https://doi.org/10.1113/JP284158 ; PMID: 39162309 , Aug-2024
Articles in Peer-reviewed Journals Xu J, Haigney MC, Levine BD, Dineen EH. "The tactical athlete: Definitions, cardiovascular assessment, and management, and "Fit for Duty" Standards." Cardiol Clin. 2023 Feb;41(1):93-105. Review. https://doi.org/10.1016/j.ccl.2022.08.008 ; PMID: 36368814 , Feb-2023
Conference Materials (Downloadable) Chauhan S, Bungo MW, Lindner JR, Koneru S, Budoff MJ, Ehrenborg KS, Macias BR, Martin DS, Levine BD. "Coronary anatomy and physiology during 1 year in space with assessment of the risk of developing atrial fibrillation. " 2025 NASA Human Research Program Investigators' Workshop, Galveston, Texas, January 28-30, 2025. , Jan-2025 HRP Poster 2025.ppt (2,329 KB)
Project Title:  Coronary Anatomy and Physiology During 1 Year in Space Reduce
Images: icon  Fiscal Year: FY 2024 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 04/20/2020  
End Date: 04/19/2034  
Task Last Updated: 07/18/2024 
Download Task Book report in PDF pdf
Principal Investigator/Affiliation:   Levine, Benjamin D M.D. / The University of Texas Southwestern Medical Center at Dallas 
Address:  Institute for Exercise and Environmental Medicine (IEEM) 
7232 Greenville Ave, Suite 435 
Dallas , TX 75231-5129 
Email: benjaminlevine@texashealth.org 
Phone: 214-345-4619  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: The University of Texas Southwestern Medical Center at Dallas 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bungo, Michael  M.D. University of Texas Health Science Center at Houston 
Lindner, Jonathan R. M.D. Oregon Health & Science University 
Key Personnel Changes / Previous PI: PI Benjamin D. Levine, MD ; CoI Michael W. Bungo, MD ; CoI Jonathan R. Lindner, MD [Note Linda Loerch is no longer CoI]
Project Information: Grant/Contract No. 80NSSC20K0987 
Responsible Center: NASA JSC 
Grant Monitor: Brocato, Becky  
Center Contact:  
becky.brocato@nasa.gov 
Unique ID: 13900 
Solicitation / Funding Source: 2019 HERO 80JSC018N0001-HHCHFBP: Human Health Countermeasures, Human Factors, Behavioral Performance. Appendix D 
Grant/Contract No.: 80NSSC20K0987 
Project Type: Flight 
Flight Program:  
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Cardiovascular:Risk of Cardiovascular Adaptations Contributing to Adverse Mission Performance and Health Outcomes
Human Research Program Gaps: (1) CV-101:Determine whether long-duration weightlessness and/or reduced gravity induces cardiovascular structural and functional adaptations that contribute to an increased risk of a cardiovascular event or and disease.
(2) CV-102:Determine whether space radiation induces cardiovascular structural and functional adaptations and/or oxidative stress and damage (OSaD)/inflammation that contribute to an increased risk of a cardiovascular event or and disease.
Flight Assignment/Project Notes: NOTE: End date is now 4/19/2034 per HHC element and NSSC information (Ed., 6/21/21)

Task Description: Since the majority of experienced astronauts are middle aged, they are at risk for developing serious cardiovascular events such as a myocardial infarction or sudden cardiac death, especially during high intensity exertion. Studies led to the current flight medicine practice of screening all astronaut candidates (and following all active crew members) with coronary artery calcium (CAC) scoring. However, atherosclerosis is a progressive process. The development of vascular calcification may be preceded by substantial non-calcified plaque, which may be most prone to rupture and cause an acute coronary syndrome. Radiation and inflammation may exacerbate this natural history. Coronary atherosclerosis impairs coronary endothelial function which can then both initiate and stimulate progression of atherosclerosis. Recent flight studies have suggested that non-coronary vascular beds may stiffen with reduced vascular reserve during 6-month International Space Station (ISS) missions, and ground-based studies have identified the surprising capacity for coronary atherosclerosis to evolve rapidly under extreme stress. In addition, the Principal Investigator (PI) team recently completed the Integrated CardioVascular (ICV) study that demonstrated: a) although cardiac arrhythmias did not increase in space in most astronauts, unexpectedly, left atrial (LA) size increased out of proportion to the changes in left ventricular (LV) size; and b) there was a subset of crew (1/13 or 8%) who had substantial increases in both ventricular and atrial arrhythmias. These data raise the specter of increased risk for atrial fibrillation (AF), the most common arrhythmia in the US which occurs a decade earlier in astronauts than in the general population. We speculate that the combination of spaceflight plus exercise countermeasures could magnify LA dilation and lead to AF during a 2-3 yr Mars mission. AF in astronauts is a particular concern with prolonged spaceflight because of limited access to care and the risk of impaired exercise performance, poorly controlled ventricular response, deterioration of ventricular function, and arterial emboli (including stroke).

Research Impact/Earth Benefits: Learning more about the natural progression of atherosclerosis in the spaceflight environment may have "spin-off" benefits for characterizing these processes in terrestrial populations. In addition, out exploratory aim in this project is to determine if a blood biomarker panel might be predictive of alterations in the atherosclerotic process. Should this prove useful, the direct benefit to clinical care on Earth would be significant.

Task Progress & Bibliography Information FY2024 
Task Progress: Task Update per the PI (Ed., 7/18/24)

During this past year, the Coronary team has advanced our project considerably. Two astronauts have gone through all testing including pre-flight, in-flight for 6 months aboard the International Space Station (ISS), and initial post-flight measures; a third has had all pre-flight baseline data collection (BDC) completed and is currently on the ISS. A 4th subject will have their pre-flight BDC performed the 3rd week in May; 2 other astronauts have consented to the studies, and the timing of their BDC and flight are being evaluated by the NASA Research Operations and Integration (ROI) team. Key accomplishments include:

1). Regular meetings with the Complement of Integrated Protocols for Human Exploration Research (CIPHER) team – including Research Operations and Integration (ROI), the NASA Johnson Space Center (JSC) Cardiovascular Lab, and the Principal Investigator (PI) teams. 2). Completion of practice dry runs for all aspects of our experiments and demonstrated feasibility and technical readiness. 3). Completion of practice wet runs using volunteers from the JSC Human Subjects Database, demonstrating the team’s ability to accomplish the experiments with high data quality and adherence to timelines. 4). Completion of baseline testing (BDC) on 3 crewmembers. 5). Completion of in-flight and early post-flight testing on 2 crewmembers; one crew member has had their first in-flight session completed, and we are awaiting their second inflight session as well as post flight. 6). Consented 3 additional crewmembers; one is scheduled for pre-flight testing the third week in May; 2 others are being evaluated by ROI for scheduling. 7). Presented de-identified data regarding the studied astronauts at the NASA Human Research Program (HRP) Investigators' Workshop (IWG) in February 2024.

[Ed. Note: CIPHER is the short title for a set of 14 studies sponsored by NASA and international partner agencies ( https://www.nasa.gov/feature/experiments-to-unlock-how-human-bodies-react-to-long-space-journeys ). CIPHER stands for "Complement of Integrated Protocols for Human Exploration Research".]

Bibliography: Description: (Last Updated: 05/20/2025) 

Show Cumulative Bibliography
 
 None in FY 2024
Project Title:  Coronary Anatomy and Physiology During 1 Year in Space Reduce
Images: icon  Fiscal Year: FY 2023 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 04/20/2020  
End Date: 04/19/2034  
Task Last Updated: 02/16/2023 
Download Task Book report in PDF pdf
Principal Investigator/Affiliation:   Levine, Benjamin D M.D. / The University of Texas Southwestern Medical Center at Dallas 
Address:  Institute for Exercise and Environmental Medicine (IEEM) 
7232 Greenville Ave, Suite 435 
Dallas , TX 75231-5129 
Email: benjaminlevine@texashealth.org 
Phone: 214-345-4619  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: The University of Texas Southwestern Medical Center at Dallas 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bungo, Michael  M.D. University of Texas Health Science Center at Houston 
Lindner, Jonathan R. M.D. Oregon Health & Science University 
Key Personnel Changes / Previous PI: PI Benjamin D. Levine, MD ; CoI Michael W. Bungo, MD ; CoI Jonathan R. Lindner, MD [Note Linda Loerch is no longer CoI]
Project Information: Grant/Contract No. 80NSSC20K0987 
Responsible Center: NASA JSC 
Grant Monitor: Brocato, Becky  
Center Contact:  
becky.brocato@nasa.gov 
Unique ID: 13900 
Solicitation / Funding Source: 2019 HERO 80JSC018N0001-HHCHFBP: Human Health Countermeasures, Human Factors, Behavioral Performance. Appendix D 
Grant/Contract No.: 80NSSC20K0987 
Project Type: Flight 
Flight Program:  
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Cardiovascular:Risk of Cardiovascular Adaptations Contributing to Adverse Mission Performance and Health Outcomes
Human Research Program Gaps: (1) CV-101:Determine whether long-duration weightlessness and/or reduced gravity induces cardiovascular structural and functional adaptations that contribute to an increased risk of a cardiovascular event or and disease.
(2) CV-102:Determine whether space radiation induces cardiovascular structural and functional adaptations and/or oxidative stress and damage (OSaD)/inflammation that contribute to an increased risk of a cardiovascular event or and disease.
Flight Assignment/Project Notes: NOTE: End date is now 4/19/2034 per HHC element and NSSC information (Ed., 6/21/21)

Task Description: Since the majority of experienced astronauts are middle aged, they are at risk for developing serious cardiovascular events such as a myocardial infarction or sudden cardiac death, especially during high intensity exertion. Studies led to the current flight medicine practice of screening all astronaut candidates (and following all active crew members) with coronary artery calcium (CAC) scoring. However, atherosclerosis is a progressive process. The development of vascular calcification may be preceded by substantial non-calcified plaque, which may be most prone to rupture and cause an acute coronary syndrome. Radiation and inflammation may exacerbate this natural history. Coronary atherosclerosis impairs coronary endothelial function which can then both initiate and stimulate progression of atherosclerosis. Recent flight studies have suggested that non-coronary vascular beds may stiffen with reduced vascular reserve during 6-month International Space Station (ISS) missions, and ground-based studies have identified the surprising capacity for coronary atherosclerosis to evolve rapidly under extreme stress. In addition, the Principal Investigator (PI) team recently completed the Integrated CardioVascular (ICV) study that demonstrated: a) although cardiac arrhythmias did not increase in space in most astronauts, unexpectedly, left atrial (LA) size increased out of proportion to the changes in left ventricular (LV) size; and b) there was a subset of crew (1/13 or 8%) who had substantial increases in both ventricular and atrial arrhythmias. These data raise the specter of increased risk for atrial fibrillation (AF), the most common arrhythmia in the US which occurs a decade earlier in astronauts than in the general population. We speculate that the combination of spaceflight plus exercise countermeasures could magnify LA dilation and lead to AF during a 2-3 yr Mars mission. AF in astronauts is a particular concern with prolonged spaceflight because of limited access to care and the risk of impaired exercise performance, poorly controlled ventricular response, deterioration of ventricular function, and arterial emboli (including stroke).

Research Impact/Earth Benefits: Learning more about the natural progression of atherosclerosis in the spaceflight environment may have "spin-off" benefits for characterizing these processes in terrestrial populations. In addition, out exploratory aim in this project is to determine if a blood biomarker panel might be predictive of alterations in the atherosclerotic process. Should this prove useful, the direct benefit to clinical care on Earth would be significant.

Task Progress & Bibliography Information FY2023 
Task Progress: During this past year, the Coronary team has moved inexorably to implementation to flight with multiple informed consent briefings, and practice sessions (“dry and wet runs”) in the NASA Johnson Space Center (JSC) Cardiovascular Lab as well as at the imaging center at Baylor College of Medicine. We have performed baseline data collection on our first subject and consented 2 others.

Key accomplishments include:

1). Regular meetings with Complement of Integrated Protocols for Human Exploration Research (CIPHER) team including Research Integration (ROI), JSC Cardiovascular Lab, and the Principal Investigator (PI) teams. 2). Completion of practice dry runs for all aspects of our experiments and demonstrated feasibility and technical readiness. 3). Completion of practice wet runs using volunteers from the JSC Human Subjects Database, demonstrating the team’s ability to accomplish the experiments with high data quality and adherence to timelines. 4). Completed baseline data collection on 1 subject with excellent data quality, and subject satisfaction. Although there were a few hiccups regarding the standardization of pregnancy testing in female subjects, this problem was resolved, and good practices are in place. 5). Refined video presentations for informed consent briefings and presented our part of the CIPHER experiments to multiple crews. Two additional crew members have consented, though one was ultimately withdrawn by NASA. 6). Maintained (Institutional Review Board) IRB approval for all experiments involving multiple modifications. This was a mammoth effort that was ultimately managed smoothly. 7). Posters presented at annual Human Research Program (HRP) meeting with active participation by the investigators.

Bibliography: Description: (Last Updated: 05/20/2025) 

Show Cumulative Bibliography
 
Articles in Peer-reviewed Journals Levine BD, Nicol ED, Davos CH. "Space: The final frontier?" 2022 Aug 5;29(10):1396-1398. https://doi.org/10.1093/eurjpc/zwac125 ; PubMed PMID: 35711101 , Aug-2022
Articles in Peer-reviewed Journals Roldan P, Ravi S, Hodovan J, Belcik JT, Heitner SB, Masri A, Lindner JR. "Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy." Cardiovasc Ultrasound. 2022 Sep 19;20:23. https://doi.org/10.1186/s12947-022-00293-2 ; PubMed PMID: 36117179 PubMed PMID: PMC9484161 , Sep-2022
Project Title:  Coronary Anatomy and Physiology During 1 Year in Space Reduce
Images: icon  Fiscal Year: FY 2022 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 04/20/2020  
End Date: 04/19/2034  
Task Last Updated: 02/15/2022 
Download Task Book report in PDF pdf
Principal Investigator/Affiliation:   Levine, Benjamin D M.D. / The University of Texas Southwestern Medical Center at Dallas 
Address:  Institute for Exercise and Environmental Medicine (IEEM) 
7232 Greenville Ave, Suite 435 
Dallas , TX 75231-5129 
Email: benjaminlevine@texashealth.org 
Phone: 214-345-4619  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: The University of Texas Southwestern Medical Center at Dallas 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bungo, Michael  M.D. University of Texas Health Science Center at Houston 
Lindner, Jonathan R. M.D. Oregon Health & Science University 
Key Personnel Changes / Previous PI: PI Benjamin D. Levine, MD ; CoI Michael W. Bungo, MD ; CoI Jonathan R. Lindner, MD [Note Linda Loerch is no longer CoI]
Project Information: Grant/Contract No. 80NSSC20K0987 
Responsible Center: NASA JSC 
Grant Monitor: Brocato, Becky  
Center Contact:  
becky.brocato@nasa.gov 
Unique ID: 13900 
Solicitation / Funding Source: 2019 HERO 80JSC018N0001-HHCHFBP: Human Health Countermeasures, Human Factors, Behavioral Performance. Appendix D 
Grant/Contract No.: 80NSSC20K0987 
Project Type: Flight 
Flight Program:  
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Cardiovascular:Risk of Cardiovascular Adaptations Contributing to Adverse Mission Performance and Health Outcomes
Human Research Program Gaps: (1) CV-101:Determine whether long-duration weightlessness and/or reduced gravity induces cardiovascular structural and functional adaptations that contribute to an increased risk of a cardiovascular event or and disease.
(2) CV-102:Determine whether space radiation induces cardiovascular structural and functional adaptations and/or oxidative stress and damage (OSaD)/inflammation that contribute to an increased risk of a cardiovascular event or and disease.
Flight Assignment/Project Notes: NOTE: End date is now 4/19/2034 per HHC element and NSSC information (Ed., 6/21/21)

Task Description: Since the majority of experienced astronauts are middle aged, they are at risk for developing serious cardiovascular events such as a myocardial infarction or sudden cardiac death, especially during high intensity exertion. Studies led to the current flight medicine practice of screening all astronaut candidates (and following all active crew members) with coronary artery calcium (CAC) scoring. However, atherosclerosis is a progressive process. The development of vascular calcification may be preceded by substantial non-calcified plaque, which may be most prone to rupture and cause an acute coronary syndrome. Radiation and inflammation may exacerbate this natural history. Coronary atherosclerosis impairs coronary endothelial function which can then both initiate and stimulate progression of atherosclerosis. Recent flight studies have suggested that non-coronary vascular beds may stiffen with reduced vascular reserve during 6-month International Space Station (ISS) missions, and ground-based studies have identified the surprising capacity for coronary atherosclerosis to evolve rapidly under extreme stress. In addition, the Principal Investigator (PI) team recently completed the Integrated CardioVascular (ICV) study that demonstrated: a) although cardiac arrhythmias did not increase in space in most astronauts, unexpectedly, left atrial (LA) size increased out of proportion to the changes in left ventricular (LV) size; and b) there was a subset of crew (1/13 or 8%) who had substantial increases in both ventricular and atrial arrhythmias. These data raise the specter of increased risk for atrial fibrillation (AF), the most common arrhythmia in the US which occurs a decade earlier in astronauts than in the general population. We speculate that the combination of spaceflight plus exercise countermeasures could magnify LA dilation and lead to AF during a 2-3 yr Mars mission. AF in astronauts is a particular concern with prolonged spaceflight because of limited access to care and the risk of impaired exercise performance, poorly controlled ventricular response, deterioration of ventricular function, and arterial emboli (including stroke).

Research Impact/Earth Benefits: Learning more about the natural progression of atherosclerosis in the spaceflight environment may have "spin-off" benefits for characterizing these processes in terrestrial populations. In addition, out exploratory aim in this project is to determine if a blood biomarker panel might be predictive of alterations in the atherosclerotic process. Should this prove useful, the direct benefit to clinical care on Earth would be significant.

Task Progress & Bibliography Information FY2022 
Task Progress: This past year has marked the transition to full integration within the Complement of Integrated Protocols for Human Exploration Research (CIPHER) complement of experiments. Key accomplishments include: 1). Regular meetings with CIPHER team, including NASA Research Operations and Integration (ROI), NASA Johnson Space Center (JSC) Cardiovascular Lab, and the Principal Investigator (PI) teams 2). Completion of Science Verification Test for all planned experiments 3). Completed and maintained Institutional Review Board (IRB) approval for all experiments 4). Development of detailed step by step protocols for pre- and post-flight experiments to be performed in conjunction with the JSC Cardiovascular lab. These protocols focused on two major activities: a) the myocardial contrast echo (MCE) experiments, and b) the development of strategies to increase stability and adherence of the electrocardiogram (ECG) patch monitor. a). MCE experiments: i. all needed equipment and drugs were identified, purchased, and are now stored onsite at JSC; ii. after much back and forth, finalized the use of Philips Epiq 7 as the primary echocardiographic machine for all experiments; iii. accomplishment of both in-person and virtual training of David Martin, JSC sonographer with Dr. Lindner to ensure adequate skill acquisition; iv. scheduling of both "dry" and "wet" runs for practice experiments to be performed just prior to the first baseline data collection sessions (BDCs). b). Patch monitor: i. identified and customized a system called "Not Just A Patch" (NJAP) to ensure adequate skin adherence during all normal astronaut activities, both on earth and on the ground; ii. practiced application with JSC ROI team to ensure adequate training; iii. performed practice experiments and verified high quality data can be acquired and analyzed by the PI team using this approach 5). Obtained site IRB approval for all imaging experiments to be performed at Baylor College of Medicine (coronary computed tomography angiography/CTA and magnetic resonance imaging/MRI experiments) for pre- and post-flight experiments. Developed detailed timelines to ensure all experiments can be obtained within the proposed time requirements. Scheduled practice runs for the imaging experiments using non-astronaut volunteers. 6). Developed informed consent documents in conjunction with ROI team. Created video clips to be integrated by JSC team, reviewed draft version, and established a collaboration between JSC and University of Texas Southwestern Medical Center (UTSW) expert media teams to improve immune checkpoint blockage (ICB) quality and understanding.

Bibliography: Description: (Last Updated: 05/20/2025) 

Show Cumulative Bibliography
 
 None in FY 2022
Project Title:  Coronary Anatomy and Physiology During 1 Year in Space Reduce
Images: icon  Fiscal Year: FY 2021 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 04/20/2020  
End Date: 04/19/2034  
Task Last Updated: 02/02/2021 
Download Task Book report in PDF pdf
Principal Investigator/Affiliation:   Levine, Benjamin D M.D. / The University of Texas Southwestern Medical Center at Dallas 
Address:  Institute for Exercise and Environmental Medicine (IEEM) 
7232 Greenville Ave, Suite 435 
Dallas , TX 75231-5129 
Email: benjaminlevine@texashealth.org 
Phone: 214-345-4619  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: The University of Texas Southwestern Medical Center at Dallas 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bungo, Michael  M.D. University of Texas Health Science Center at Houston 
Lindner, Jonathan R. M.D. Oregon Health & Science University 
Key Personnel Changes / Previous PI: PI Benjamin D. Levine, MD ; CoI Michael W. Bungo, MD ; CoI Jonathan R. Lindner, MD [Note Linda Loerch is no longer CoI]
Project Information: Grant/Contract No. 80NSSC20K0987 
Responsible Center: NASA JSC 
Grant Monitor: Brocato, Becky  
Center Contact:  
becky.brocato@nasa.gov 
Unique ID: 13900 
Solicitation / Funding Source: 2019 HERO 80JSC018N0001-HHCHFBP: Human Health Countermeasures, Human Factors, Behavioral Performance. Appendix D 
Grant/Contract No.: 80NSSC20K0987 
Project Type: Flight 
Flight Program:  
TechPort: No 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Cardiovascular:Risk of Cardiovascular Adaptations Contributing to Adverse Mission Performance and Health Outcomes
Human Research Program Gaps: (1) CV-101:Determine whether long-duration weightlessness and/or reduced gravity induces cardiovascular structural and functional adaptations that contribute to an increased risk of a cardiovascular event or and disease.
(2) CV-102:Determine whether space radiation induces cardiovascular structural and functional adaptations and/or oxidative stress and damage (OSaD)/inflammation that contribute to an increased risk of a cardiovascular event or and disease.
Flight Assignment/Project Notes: NOTE: End date is now 4/19/2034 per HHC element and NSSC information (Ed., 6/21/21)

Task Description: Since the majority of experienced astronauts are middle aged, they are at risk for developing serious cardiovascular events such as a myocardial infarction or sudden cardiac death, especially during high intensity exertion. Studies led to the current flight medicine practice of screening all astronaut candidates (and following all active crew members) with coronary artery calcium (CAC) scoring. However, atherosclerosis is a progressive process. The development of vascular calcification may be preceded by substantial non-calcified plaque, which may be most prone to rupture and cause an acute coronary syndrome. Radiation and inflammation may exacerbate this natural history. Coronary atherosclerosis impairs coronary endothelial function which can then both initiate and stimulate progression of atherosclerosis. Recent flight studies have suggested that non-coronary vascular beds may stiffen with reduced vascular reserve during 6-month International Space Station (ISS) missions, and ground-based studies have identified the surprising capacity for coronary atherosclerosis to evolve rapidly under extreme stress. In addition, the Principal Investigator (PI) team recently completed the Integrated CardioVascular (ICV) study that demonstrated: a) although cardiac arrhythmias did not increase in space in most astronauts, unexpectedly, left atrial (LA) size increased out of proportion to the changes in left ventricular (LV) size; and b) there was a subset of crew (1/13 or 8%) who had substantial increases in both ventricular and atrial arrhythmias. These data raise the specter of increased risk for atrial fibrillation (AF), the most common arrhythmia in the US which occurs a decade earlier in astronauts than in the general population. We speculate that the combination of spaceflight plus exercise countermeasures could magnify LA dilation and lead to AF during a 2-3 yr Mars mission. AF in astronauts is a particular concern with prolonged spaceflight because of limited access to care and the risk of impaired exercise performance, poorly controlled ventricular response, deterioration of ventricular function, and arterial emboli (including stroke).

Research Impact/Earth Benefits: Learning more about the natural progression of atherosclerosis in the spaceflight environment may have "spin-off" benefits for characterizing these processes in terrestrial populations. In addition, out exploratory aim in this project is to determine if a blood biomarker panel might be predictive of alterations in the atherosclerotic process. Should this prove useful, the direct benefit to clinical care on Earth would be significant.

Task Progress & Bibliography Information FY2021 
Task Progress: It is anticipated that the results of this study will provide foundational data for exploration class missions to improve “personalized” risk assessment through high resolution multimodality phenotyping of cardiovascular structure and function. The study aims directly address Gaps CVD-101 (To determine whether long-duration weightlessness induces cardiovascular structural and functional changes and/or oxidative stress & damage (OSaD)/inflammation, that can contribute to development of disease)) and CVD-102 (To determine whether space radiation induces cardiovascular structural and functional changes and/or oxidative stress & damage (OSaD)/inflammation, that can contribute to development of disease)). At this point in time we have completed the first year of definition phase and are awaiting flight assignment to begin data collection. It is anticipated that baseline data collection will occur during 2021 with the first participating +flight crewmembers launching circa January 2022.

Bibliography: Description: (Last Updated: 05/20/2025) 

Show Cumulative Bibliography
 
Articles in Peer-reviewed Journals Wu MD, Hodovan J, Kumar K, Moulton B, Olson S, Gilbert A, Wood MD, Lindner JR. "Ponatinib coronary microangiopathy: Novel bedside diagnostic approach and management with N-acetylcysteine." Blood Adv. 2020 Sep 8;4(17):4083-5. https://doi.org/10.1182/bloodadvances.2020002644 ; PMID: 32870969; PMCID: PMC7479961 , Sep-2020
Articles in Peer-reviewed Journals Lindner JR. "Limb perfusion imaging in peripheral artery disease." JACC Cardiovasc Imaging. 2020 Nov 13:S1936-878X(20)30921-9. Editorial Available online 18 November 2020. https://doi.org/10.1016/j.jcmg.2020.10.011 ; PMID: 33221233 , Nov-2020
Project Title:  Coronary Anatomy and Physiology During 1 Year in Space Reduce
Images: icon  Fiscal Year: FY 2020 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 04/20/2020  
End Date: 04/19/2021  
Task Last Updated: 06/30/2020 
Download Task Book report in PDF pdf
Principal Investigator/Affiliation:   Levine, Benjamin D M.D. / The University of Texas Southwestern Medical Center at Dallas 
Address:  Institute for Exercise and Environmental Medicine (IEEM) 
7232 Greenville Ave, Suite 435 
Dallas , TX 75231-5129 
Email: benjaminlevine@texashealth.org 
Phone: 214-345-4619  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: The University of Texas Southwestern Medical Center at Dallas 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bungo, Michael  M.D. University of Texas Health Science Center at Houston 
Loerch, Linda  M.S. NASA Johnson Space Center 
Project Information: Grant/Contract No. 80NSSC20K0987 
Responsible Center: NASA JSC 
Grant Monitor: Norsk, Peter  
Center Contact:  
Peter.norsk@nasa.gov 
Unique ID: 13900 
Solicitation / Funding Source: 2019 HERO 80JSC018N0001-HHCHFBP: Human Health Countermeasures, Human Factors, Behavioral Performance. Appendix D 
Grant/Contract No.: 80NSSC20K0987 
Project Type: Flight 
Flight Program:  
TechPort: No 
No. of Post Docs:  
No. of PhD Candidates:  
No. of Master's Candidates:  
No. of Bachelor's Candidates:  
No. of PhD Degrees:  
No. of Master's Degrees:  
No. of Bachelor's Degrees:  
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Cardiovascular:Risk of Cardiovascular Adaptations Contributing to Adverse Mission Performance and Health Outcomes
Human Research Program Gaps: (1) CV-101:Determine whether long-duration weightlessness and/or reduced gravity induces cardiovascular structural and functional adaptations that contribute to an increased risk of a cardiovascular event or and disease.
(2) CV-102:Determine whether space radiation induces cardiovascular structural and functional adaptations and/or oxidative stress and damage (OSaD)/inflammation that contribute to an increased risk of a cardiovascular event or and disease.
Task Description: Since the majority of experienced astronauts are middle aged, they are at risk for developing serious cardiovascular events such as a myocardial infarction or sudden cardiac death, especially during high intensity exertion. Such events are life-threatening for the astronaut, and mission threatening for NASA. The principal investigator and colleagues have been leaders in developing strategies to identify asymptomatic individuals who may be at highest risk for such cardiovascular events. These studies led to the current flight medicine practice of screening all astronaut candidates (and following all active crew members) with coronary artery calcium (CAC) scoring.

However atherosclerosis is a progressive process. So it would be possible for an astronaut to develop increasing CAC (and atherosclerosis) over time. Moreover, the development of vascular calcification may be preceded by substantial non-calcified plaque, which may be most prone to rupture and cause an acute coronary syndrome. Finally, coronary atherosclerosis impairs coronary endothelial function which can then both initiate and stimulate progression of atherosclerosis; myocardial contrast echocardiography (MCE) can non-invasively quantify coronary microvascular function to complement the structural assessment by coronary computerized tomography angiography (cCTA).

Important for this project and the Request for Actions (RFA) is the potential for space radiation to accelerate atherosclerosis. Recent flight studies have suggested that non-coronary vascular beds may stiffen with reduced vascular reserve during 6 month International Space Station (ISS) missions, and ground based studies have identified the surprising capacity for coronary atherosclerosis to evolve rapidly under extreme stress. The global object of this project is to determine the effect of incremental doses of spaceflight on coronary anatomy and physiology, and to identify biomarkers that may be useful for early detection of accelerated atherosclerosis. To accomplish this objective, we propose to complete the following specific aims:

Specific Aim 1: to test the hypothesis that coronary atherosclerosis will be accelerated by 1 year of spaceflight. We will perform cCTA: a) 1 year before flight upon crew selection; b) within 4-8 weeks of flight; c) soon (within 1-2 weeks) after 1 year in space; and d) after 1 year recovery. This strategy will allow us to compare the trajectory of coronary atherosclerosis before and after prolonged spaceflight. The extent of calcified and non-calcified plaque will be quantified, and markers of plaque vulnerability will be assessed. To provide context, we will also compare these data to well matched controls from the Cooper Clinic Longitudinal Study and the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) cCTA registry. Specific Aim 2: to test the hypothesis that 1 year in space will impair coronary endothelial function and vasomotor reactivity. We will perform MCE before and after adenosine pre, in, and post-flight to quantify coronary microvascular function. Exploratory Aim 3: to test the hypothesis that a multimodality biomarker panel including blood (hs-troponin, NTproBNP, markers of oxidative stress and DNA damage) and relevant imaging (CAC, cCTA, MCE) can quantify risk of accelerated atherosclerosis before and during long duration flight.

This study will provide critically important information regarding changes in coronary structure and function during 1 year in space, and will form the knowledge base to assess cardiovascular risk from multiyear exploration class missions. If the changes in the coronary circulation are as pronounced as the peripheral circulation, specific plans for monitoring and management in space can be developed including prevention and treatment. These aims will directly address Gap Degen-7 (Are there synergistic effects from other spaceflight factors (e.g., altered gravity (µ-gravity), stress, altered immune function, altered circadian rhythms, or other) that modify space radiation-induced degenerative diseases in a clinically significant manner?) and Gap CV1 (What are the in-flight alterations in cardiac structure and function?), and CV8 (Can manifestations of sub-clinical or environmentally induced cardiovascular diseases during spaceflight be predicted?).

Research Impact/Earth Benefits:

Task Progress & Bibliography Information FY2020 
Task Progress: New project for FY2020.

Bibliography: Description: (Last Updated: 05/20/2025) 

Show Cumulative Bibliography
 
 None in FY 2020