Cardiac Health for Astronauts: Coronary Calcification Scores and CRP as Criteria for Selection and Retention
Hamilton DR, Murray JD, Ball CG. Cardiac health for astronauts: coronary calcification scores and CRP as criteria for selection and retention. Aviat Space Environ Med 2006; 77:377–387.
Due to the limited treatment and return capabilities of most space vehicles, an in-flight cardiac event could result in significant mission impact or even failure. The current literature supports including electron-beam computed tomography (EBCT) and highly selective C-reactive protein (hsCRP) for diagnosis of coronary artery disease (CAD) in asymptomatic, low-pretest probability cohorts. This paper will examine the issues surrounding adding these tests to astronaut retention and selection algorithms. An evidenced-based literature review was performed and consensus obtained from subject-matter experts to create novel cardiac screening algorithms for astronaut applicants and the current astronaut corps. The main focus of this paper is to derive an evidenced-based approach for improving the diagnosis of significant CAD using EBCT and hsCRP testing. The recommended initial astronaut selection and long-duration mission assignment screening algorithms use EBCT-derived calcium scores and serum hsCRP levels to screen for CAD and predict individual cardiac risk. The current medical evidence is compelling for the international space medicine community to consider: 1.) Astronaut candidates with a coronary artery calcium score > 0 should be disqualified from initial selection; 2.) Astronauts with a coronary artery calcium score > 100 should be disqualified from selection for long-duration missions; 3.) Elevated hsCRP is a reliable risk factor for helping predict future cardiac events that should warrant primary prevention but not necessarily medical disqualification.
Due to the limited treatment and return capabilities of most space vehicles, an in-flight cardiac event could result in significant mission impact or even failure. The current literature supports including electron-beam computed tomography (EBCT) and highly selective C-reactive protein (hsCRP) for diagnosis of coronary artery disease (CAD) in asymptomatic, low-pretest probability cohorts. This paper will examine the issues surrounding adding these tests to astronaut retention and selection algorithms. An evidenced-based literature review was performed and consensus obtained from subject-matter experts to create novel cardiac screening algorithms for astronaut applicants and the current astronaut corps. The main focus of this paper is to derive an evidenced-based approach for improving the diagnosis of significant CAD using EBCT and hsCRP testing. The recommended initial astronaut selection and long-duration mission assignment screening algorithms use EBCT-derived calcium scores and serum hsCRP levels to screen for CAD and predict individual cardiac risk. The current medical evidence is compelling for the international space medicine community to consider: 1.) Astronaut candidates with a coronary artery calcium score > 0 should be disqualified from initial selection; 2.) Astronauts with a coronary artery calcium score > 100 should be disqualified from selection for long-duration missions; 3.) Elevated hsCRP is a reliable risk factor for helping predict future cardiac events that should warrant primary prevention but not necessarily medical disqualification.
Keywords: International Space Station; Mars; Moon; astronaut; c-reactive protein; cholesterol; coronary artery disease; electron-beam computed tomography; risk factors; space exploration; spaceflight
Document Type: Research Article
Publication date: 01 April 2006
- The peer-reviewed monthly journal, Aviation, Space, and Environmental Medicine (ASEM) provides contact with physicians, life scientists, bioengineers, and medical specialists working in both basic medical research and in its clinical applications. It is the most used and cited journal in its field. ASEM is distributed to more than 80 nations.
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