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  • Review Article
  • Published:

Computational modelling of cardiovascular pathophysiology to risk stratify commercial spaceflight

Nature Reviews Cardiology volume 21, pages 667–681 (2024)Cite this article

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Abstract

For more than 60 years, humans have travelled into space. Until now, the majority of astronauts have been professional, government agency astronauts selected, in part, for their superlative physical fitness and the absence of disease. Commercial spaceflight is now becoming accessible to members of the public, many of whom would previously have been excluded owing to unsatisfactory fitness or the presence of cardiorespiratory diseases. While data exist on the effects of gravitational and acceleration (G) forces on human physiology, data on the effects of the aerospace environment in unselected members of the public, and particularly in those with clinically significant pathology, are limited. Although short in duration, these high acceleration forces can potentially either impair the experience or, more seriously, pose a risk to health in some individuals. Rather than expose individuals with existing pathology to G forces to collect data, computational modelling might be useful to predict the nature and severity of cardiovascular diseases that are of sufficient risk to restrict access, require modification, or suggest further investigation or training before flight. In this Review, we explore state-of-the-art, zero-dimensional, compartmentalized models of human cardiovascular pathophysiology that can be used to simulate the effects of acceleration forces, homeostatic regulation and ventilation–perfusion matching, using data generated by long-arm centrifuge facilities of the US National Aeronautics and Space Administration and the European Space Agency to risk stratify individuals and help to improve safety in commercial suborbital spaceflight.

Key points

  • Commercial suborbital spaceflight (CSOS) is a relatively new enterprise that, unlike traditional aviation, involves considerable acceleration (G) forces, which represents a new challenge for operators and aviation authorities who are required to develop medical safety guidelines.

  • Physiologically, CSOS participants are unlike professional astronauts, and the effects of increased G forces in these individuals are largely unknown, particularly in those with ageing or diseased cardiovascular systems.

  • Computational modelling is being used to simulate the effects of CSOS on the human cardiovascular system in various diseased and comorbid states to assess tolerance to increased G and to help to develop an evidence base to support medical guideline development.

  • Zero-dimensional, electrical analogue models are apposite for this objective, with a fully transient analysis and representation of homeostatic regulation mechanisms, species (oxygen and carbon dioxide) transport and directional G loading, which can be represented with capacitors.

  • Challenges include how clinical data are integrated and interpreted in the model and how model outputs will be validated, because exposing potentially high-risk individuals to extreme G forces might be unsafe and, therefore, unethical.

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Fig. 1: Gravitational and acceleration forces on earth and during CSOS.
Fig. 2: Representative G profiles for two variants of CSOS craft.
Fig. 3: Modelling the human cardiovascular system.

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Acknowledgements

The Sheffield-based authors developed this manuscript at the National Institute for Health and Care Research (NIHR) Sheffield Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. N.P.S. is supported by the Marsden Fund, administered by the Royal Society of New Zealand (UOA1620). P.D.M. was funded by the Wellcome Trust (214567/Z/18/Z).

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Authors and Affiliations

  1. Division of Clinical Medicine, University of Sheffield, Sheffield, UK

    Paul D. Morris, Tom A. Newman, Daniel J. Taylor, Tim Chico, Julian P. Gunn, Andrew J. Narracott, D. Rod Hose & Ian Halliday

  2. Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    Paul D. Morris, Tom A. Newman, Tim Chico & Julian P. Gunn

  3. Medical Department, Spaceflight, UK Civil Aviation Authority, Gatwick, UK

    Ryan A. Anderton

  4. The National Aeronautics and Space Administration (NASA) Johnson Space Center, Houston, TX, USA

    Karina Marshall-Goebel

  5. Aerospace Medicine Specialist Wing, Royal Air Force (RAF) Centre of Aerospace Medicine, Henlow, UK

    Joseph K. Britton

  6. KBR, Human Health Countermeasures Element, NASA Johnson Space Center, Houston, TX, USA

    Stuart M. C. Lee

  7. Victoria University of Wellington, Wellington, New Zealand

    Nicolas P. Smith

  8. Auckland Bioengineering Institute, Auckland, New Zealand

    Nicolas P. Smith

  9. Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands

    Frans N. van de Vosse

  10. Virgin Galactic Medical, Truth or Consequences, NM, USA

    Karen M. Ong

  11. Insigneo Institute, University of Sheffield, Sheffield, UK

    Andrew J. Narracott, D. Rod Hose & Ian Halliday

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P.D.M., R.A.A., A.J.N., D.R.H. and I.H. originated the idea for the manuscript and researched the data for the article. All the authors wrote the manuscript and reviewed/edited it before submission.

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Morris, P.D., Anderton, R.A., Marshall-Goebel, K. et al. Computational modelling of cardiovascular pathophysiology to risk stratify commercial spaceflight. Nat Rev Cardiol 21, 667–681 (2024). https://doi.org/10.1038/s41569-024-01047-5

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