LBBB in aircrew with low cardiac risk: diagnostic application of multislice CT.
BACKGROUND
Because of its excellent negative predictive value for diagnosing coronary stenoses, multislice computed tomography (MSCT) may be a way to assess the absence of significant coronary stenosis. We discussed its place in aeromedical decision-making for aircrew members with a low level of cardiovascular risk factors and acquired left bundle branch block (LBBB).


RESULTS
During the period 2002-2004, 12 male aircrew members (mean age: 42.9 yr) with acquired LBBB were admitted to our cardiovascular and aeronautical department. The exploration of LBBB was classical, including an electrophysiological study, the usual coronary angiography, and MSCT. All the morphological explorations of the coronary tree were normal.


CONCLUSIONS
In addition to complex electrophysiological mechanisms, coronary artery disease (CAD) is suspected, but remains infrequent in some EKG findings such as acquired LBBB, especially for patients with low cardiovascular risk factors as demonstrated with our aircrew members. However, in aerospace medicine the expert needs to prove the absence of CAD. The use of standard examinations (exercise stress test, stress myocardial scintigraphy, etc.) is controversial because of artifacts and a conventional coronary angiography is necessary. According to previous studies, including using a validated technique in our department (with 16-slice computed tomography), the excellent negative predictive value of MSCT (97 to 99%) may be a way to avoid invasive exploration during the investigation of a newly acquired LBBB in aviators with low cardiovascular risk.
Perrier
Eric
E
Department of Aeronautical Medicine and Cardiology, Hôpital d'Instruction des Armées Percy, Clamart, France. aerocard@claranet.fr
Manen
Olivier
O
Doireau
Philippe
P
Paul
Jean F
JF
Ghostine
Said
S
Lerecouvreux
Michel
M
Deroche
Jacques
J
Leduc
Pierre A
PA
Genero
Marilyne
M
Paris
Jean F
JF
Martel
Victor
V
Carlioz
Roland
R
Geffroy
Sylvie
S
Caussin
Christophe
C
Plotton
Christian
C
Gourbat
Jean P
JP
D000328:Adult; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*