Cardiac MRI improves cardiovascular risk stratification in hazardous occupations

Autor: Edward Nicol, Joseph Britton, Rebecca Chamley, Stefan Neubauer, Joanna d’Arcy, Iain Parsons, David Holdsworth, Arun J Baksi, Christopher W. Pavitt
Rok vydání: 2019
Předmět:
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
Time Factors
Health Status
Cardiomyopathy
030218 nuclear medicine & medical imaging
Workflow
Electrocardiography
0302 clinical medicine
Return to Work
Risk Factors
Radiological and Ultrasound Technology
medicine.diagnostic_test
Middle Aged
musculoskeletal system
Magnetic Resonance Imaging
Occupational
Military Personnel
Cardiovascular Diseases
Risk stratification
Cardiology
cardiovascular system
Aviation medicine
Female
Medical assessment
Cardiology and Cardiovascular Medicine
circulatory and respiratory physiology
Adult
Risk
medicine.medical_specialty
Occupational risk
Risk Assessment
03 medical and health sciences
Young Adult
Predictive Value of Tests
Internal medicine
medicine
Humans
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
Occupational Health
Angiology
Retrospective Studies
business.industry
Research
Reproducibility of Results
Magnetic resonance imaging
medicine.disease
Pilots
lcsh:RC666-701
Ectopy
Aircrew
business
Zdroj: Journal of Cardiovascular Magnetic Resonance
Journal of Cardiovascular Magnetic Resonance, Vol 21, Iss 1, Pp 1-9 (2019)
ISSN: 1532-429X
Popis: Background The benefit of cardiovascular magnetic resonance Imaging (CMR) in assessing occupational risk is unknown. Pilots undergo frequent medical assessment for occult disease, which threatens incapacitation or distraction during flight. ECG and examination anomalies often lead to lengthy restriction, pending full investigation. CMR provides a sensitive, specific assessment of cardiac anatomy, tissue characterisation, perfusion defects and myocardial viability. We sought to determine if CMR, when added to standard care, would alter occupational outcome. Methods A retrospective review was conducted of all personnel attending the RAF Aviation Medicine Consultation Service (AMCS) for assessment of a cardiac anomaly, over a 2-year period. Those undergoing standard of care (history, examination, exercise ECG, 24 h-Holter and transthoracic echocardiography), and those undergoing a CMR in addition, were identified. The influence of CMR upon the final decision regarding flying restriction was determined by comparing the diagnosis reached with standard of care plus CMR vs. standard of care alone. Results Of the ~ 8000 UK military aircrew, 558 personnel were seen for cardiovascular assessment. Fifty-two underwent CMR. A normal TTE did not reliably exclude abnormalities subsequently detected by CMR. Addition of CMR resulted in an upgraded occupational status in 62% of those investigated, with 37% returning to unrestricted duties. Only 8% of referrals were undiagnosed following CMR. All these were cases of borderline chamber dilatation and reduction in systolic function in whom diagnostic uncertainty remained between physiological exercise adaptation and early cardiomyopathy. Conclusions CMR increases the likelihood of a definitive diagnosis and of return to flying. This study supports early use of CMR in occupational assessment for high-hazard occupations. Electronic supplementary material The online version of this article (10.1186/s12968-019-0544-5) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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