Flying experience and cardiovascular response to rapid head-up tilt in fighter pilots

Neuro-Cardiovascular Responses to Sympathetic Stimulation in Fighter Pilots

INTRODUCTION: The chronic effects of regular exposure to high acceleration levels (G-force) on the neuro-cardiovascular system are unclear. We compared the mean arterial pressure (MAP) and cardiac autonomic modulation between nonpilots (NP) vs. military fighter (FP) and transport (TP) pilots. Additionally, we correlated the cardiac autonomic indices with the cardiorespiratory fitness and flight experience of FP.METHODS: A total of 21 FP, 8 TP, and 20 NP performed a tilt test (TT), during which beat-to-beat blood pressure and heart rate were recorded.RESULTS: No difference was detected between groups for changes in MAP and heart rate variability indices during the TT. However, the analysis of areas under the curves showed a greater increase in MAP in FP vs. TP and NP. Conversely, there was a greater decrease in indices reflecting vagal modulation in TP vs. FP and NP (rMSSD, pNN50, and SDNN), and a greater increase in heart rate and sympathovagal balance in TP vs. other groups (LF/HF). The maximal oxygen uptake was strongly correlated with the vagal reserve in FP (r = -0.74). Moreover, the total flying hours of FP were positively correlated with resting HFnu (r = 0.47) and inversely correlated with resting LFnu (r = -0.55) and LF/HF (r = -0.46).CONCLUSION: FP had a higher pressor response to TT than TP and NP. Vagal withdrawal and sympathovagal increase induced by TT in FP were similar vs. NP and attenuated vs. TP. Greater cardiorespiratory fitness and accumulated flying hours in FP seemed to favor lower sympathetic and greater vagal modulation at rest.dos Santos Rangel MV, de Sá GB, Farinatti P, Borges JP. Neuro-cardiovascular responses to sympathetic stimulation in fighter pilots. Aerosp Med Hum Perform. 2023; 94(10):761-769.

Cardiovascular autonomic regulation in fighter pilots: Lessons from active standing tests

Fighter pilots (FP) are exposed to flight accelerations and stressful situations that defy cardiovascular control during and after flight. FP presents a smaller adjustment in sympatho-vagal balance during tilt test after flight compared to baseline, suggesting a huge impact of flight on autonomic modulation to the heart. We undertake to test the hypothesis that FP will have a smaller vagal reentrance and lower sympathetic withdrawal during the recovery at the supine position after a prolonged active standing test that mimics flight hemodynamic demands. Twenty-one military personnel (20-34 years old), composed of 9 FP and 12 non-pilots (NP) matched by age, V̉O_2max and body mass index were enroled in the experimental protocol. R-R intervals were continuously recorded in the supine position for 15 min (SUP_baseline ), during the prolonged active standing test (45 min) windowed in six 5 min time frames (from ORT1 to ORT6), and a recovery period in the supine position for 15 min (SUP_recovery ). Heart rate variability was performed by spectral analysis to obtain the normalized low (LFn) and high (HFn) frequency components. The variation (Δ) from baseline (Δ = ORT6 - SUP_baseline ) and from recovery (Δ = SUP_recovery -ORT6) periods were calculated. FP had a smaller ΔLFn (sympathetic mediated) and ΔHFn (vagal meditated) during recovery after active standing as compared to NP. Both groups showed similar changes in ΔLFn and ΔHFn during orthostatic stress compared to baseline, with no differences over time. Therefore, FP show a smaller vagal reentrance and a lower sympathetic reduction during recovery at supine following active standing compared to NP.

The arterial baroreflex and inherent G tolerance

PURPOSE

High G tolerance is based on the capacity to maintain a sufficient level of arterial pressure (AP) during G load; therefore, we hypothesized that subjects with high G tolerance (H group) would have stronger arterial baroreflex responses compared to subjects with low G tolerance (L group). The carotid baroreflex was evaluated using the neck pressure method (NP), which assesses open-loop responses.

METHODS

The carotid baroreflex was tested in 16 subjects, n = 8 in the H and L group, respectively, in the supine and upright posture. Heart rate and AP were measured.

RESULTS

There were no differences between groups in the maximum slopes of the carotid baroreflex curves. However, the H group had a larger systolic and mean AP (SAP, MAP) increase to the initial hypotensive stimuli of the NP sequence in the upright position compared to the L group, 7.5 ± 6.6 vs 2.0 ± 2.4 and 4.1 ± 3.4 vs 1.1 ± 1.1 mmHg for SAP and MAP, respectively. Furthermore, the L group exhibited an increased latency between stimuli and response in AP in the upright compared to supine position, 4.1 ± 1.0 vs 3.1 ± 0.9 and 4.7 ± 1.1 vs 3.6 ± 0.9 s, for SAP and MAP. No differences in chronotropic responses were observed between the groups.

CONCLUSIONS

It is concluded that the capacity for reflexive vasoconstriction and maintained speed of the vascular baroreflex during orthostatic stress are coupled to a higher relaxed GOR tolerance.