title: LBBB in aircrew with low cardiac risk: diagnostic application of multislice CT.
abstract: 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.
authors.affiliation: Department of Aeronautical Medicine and Cardiology, Hôpital d'Instruction des Armées Percy, Clamart, France. aerocard@claranet.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Perrier
authors.forename: Olivier
authors.initials: O
authors.lastname: Manen
authors.forename: Philippe
authors.initials: P
authors.lastname: Doireau
authors.forename: Jean F
authors.initials: JF
authors.lastname: Paul
authors.forename: Said
authors.initials: S
authors.lastname: Ghostine
authors.forename: Michel
authors.initials: M
authors.lastname: Lerecouvreux
authors.forename: Jacques
authors.initials: J
authors.lastname: Deroche
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Leduc
authors.forename: Marilyne
authors.initials: M
authors.lastname: Genero
authors.forename: Jean F
authors.initials: JF
authors.lastname: Paris
authors.forename: Victor
authors.initials: V
authors.lastname: Martel
authors.forename: Roland
authors.initials: R
authors.lastname: Carlioz
authors.forename: Sylvie
authors.initials: S
authors.lastname: Geffroy
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.forename: Christian
authors.initials: C
authors.lastname: Plotton
authors.forename: Jean P
authors.initials: JP
authors.lastname: Gourbat
mesh_terms: 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*