荷兰无症状军事飞行人员冠状动脉疾病的患病率和严重程度：一项前瞻性横断面研究（SUSPECT）。
Prevalence and severity of coronary artery disease in asymptomatic military air crew in the Netherlands: a prospective, cross-sectional study (SUSPECT).
作者信息
Frijters Erik, Nathoe Hendrik, Grobben Remco, Broekhuizen Lysette, Rienks Rienk, Velthuis Birgitta
机构信息
Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
Aerospace Medicine Department, Center for Man in Aviation, Soesterberg, Netherlands.
出版信息
BMJ Open. 2025 Jun 23;15(6):e100250. doi: 10.1136/bmjopen-2025-100250.
OBJECTIVE
Coronary artery disease (CAD) is a main cause of incapacitating adverse cardiac events in aviation. Military aircrew ≥40 years in the Netherlands undergo a 5-year exercise ECG (X-ECG), which lacks precision to identify relevant CAD. The study aim was to identify the screening value of cardiac CT (CCT) in asymptomatic military aircrew.
DESIGN
Prospective, single-centre, cross-sectional study.
SETTING
Conducted at the Centre for Man in Aviation, Royal Netherlands Air Force. CT scans were performed at the University Medical Centre, Utrecht.
PARTICIPANTS
Asymptomatic military aircrew ≥40 years were asked to undergo CCT, with coronary artery calcium score (CACS) and coronary CT angiography (CCTA), following their aeromedical exam. CCT was performed in 211 participants (median age 49.3 years (43.6-52.8), 98% men, 65% pilots).
OUTCOME MEASURES
The main objective was to determine the prevalence of relevant CAD. Clinically relevant CAD (CR-CAD) is defined as CACS ≥100 and/or a stenosis ≥50%. Aeromedically relevant CAD (AR-CAD) includes CR-CAD and/or a left main stenosis >30% or an aggregate stenosis ≥120%. Secondary objectives included assessing the prevalence of mild coronary stenosis (defined as 25%-49% stenosis), the presence of high-risk plaque (HRP) features and CCT safety.
RESULTS
CR-CAD was found in 25 male aircrew (12%), with a CACS of ≥100 in 21 (10%) and a stenosis ≥50% in 10 (5%), including two with CACS 0. Two additional men had ≥120% aggregate stenosis, bringing total AR-CAD to 27 (13%). Twenty-nine men (14%) had mild stenosis. HRP features were present in 44 (21%). There were no CT-related complications. Of 196 participants who underwent X-ECG, seven showed abnormal results; one had relevant CAD.
CONCLUSIONS
Contrast-enhanced CCTA provides additional information both on high-risk features and obstructive CAD compared with CACS only. CCT is safe and is of additional value to X-ECG in a low-risk population with a high-hazard occupation.
TRIAL REGISTRATION NUMBER
NCT05508893.
目的
冠状动脉疾病（CAD）是航空领域导致致残性不良心脏事件的主要原因。荷兰年龄≥40岁的军事飞行员需接受为期5年的运动心电图（X-ECG）检查，但其识别相关CAD的准确性欠佳。本研究旨在确定心脏CT（CCT）在无症状军事飞行员中的筛查价值。
设计
前瞻性、单中心横断面研究。
地点
在荷兰皇家空军航空人员中心开展。CT扫描在乌得勒支大学医学中心进行。
参与者
年龄≥40岁的无症状军事飞行员在进行航空医学检查后被要求接受CCT检查，包括冠状动脉钙化积分（CACS）和冠状动脉CT血管造影（CCTA）。211名参与者接受了CCT检查（中位年龄49.3岁（43.6 - 52.8岁），98%为男性，65%为飞行员）。
观察指标
主要目的是确定相关CAD的患病率。临床相关CAD（CR-CAD）定义为CACS≥100且/或狭窄≥50%。航空医学相关CAD（AR-CAD）包括CR-CAD和/或左主干狭窄>30%或总狭窄≥120%。次要目的包括评估轻度冠状动脉狭窄（定义为狭窄25% - 49%）的患病率、高危斑块（HRP）特征的存在情况以及CCT的安全性。
结果
25名男性飞行员（12%）被发现患有CR-CAD，其中21名（10%）CACS≥100，10名（5%）狭窄≥50%，包括两名CACS为0的飞行员。另外两名男性总狭窄≥120%，使AR-CAD总数达到27例（13%）。29名男性（14%）有轻度狭窄。44名（21%）有HRP特征。未发生与CT相关的并发症。在接受X-ECG检查的196名参与者中，7人结果异常；其中1人患有相关CAD。
结论
与仅使用CACS相比，对比增强CCTA在高危特征和阻塞性CAD方面均能提供更多信息。CCT是安全的，在高危职业的低风险人群中，它对X-ECG具有额外价值。
试验注册号
NCT05508893。
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