Dataset Information

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations.

ABSTRACT:

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.

SUBMITTER: Holdsworth DA

PROVIDER: S-EPMC6661777 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations.

Holdsworth David A DA Parsons Iain T IT Chamley Rebecca R Britton Joseph J Pavitt Christopher C Baksi A John AJ Neubauer Stefan S d'Arcy Joanna J Nicol Edward D ED

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 20190729 1

<h4>Background</h4>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 ...[more]

PMID: 31352898

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Dataset Information

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations.

Background

Methods

Results

Conclusions

Publications

Cardiac MRI improves cardiovascular risk stratification in hazardous occupations.

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