无创检测技术在军事飞行人员疑似冠心病综合评价中的应用价值

Applicability value of non-invasive technique in comprehensive evaluation of military aircrews with suspected coronary heart disease

目的初步探讨心电图、超声心动图、平板运动试验、心脏核磁共振、核素心肌显像、计算机断层扫描血管造影(CTA)以及基于人工智能技术获得的无创血流储备分数(CTFFR)等无创检测手段在军事飞行人员疑似冠心病综合评价中的应用价值。方法回顾性分析2011年1月至2020年7月空军特色医学中心收治的可疑冠心病军事飞行人员中,各类无创检查手段的应用及其相关医学鉴定情况。结果按研究要求,共纳入临床病例71例,均进行了心电图和心脏彩超检查,69例进行了平板运动试验,63例进行了冠状动脉(简称冠脉)CTA检查,10例进行了CTFFR评估,9例进行了核素心肌显像,4例进行了心脏核磁共振检查;冠脉CTA联合CTFFR检测同冠脉造影结果符合率高;36人通过检查直接排除冠脉狭窄,其中27名飞行合格,35人经检查诊断为冠脉狭窄,其中23名飞行合格,总计放飞50例,放飞率为70.4%。结论合理选用无创检查在疑似冠心病军事飞行人员的诊断评估中具有重要价值,其中冠脉CTA联合CTFFR诊断冠心病准确率高,可为进一步的飞行鉴定提供重要依据。

Objective To explore the applicability of such non-invasive methods as electrocardiography(ECG),echocardiography,treadmill exercise test,cardiac magnetic resonance imaging,myocardial radionuclide scan,coronary computed tomographic angiography(CTA)and fractional flow reserve on CTA(CTFFR)based on artificial intelligence in the appraisal of military aircrews with suspected coronary heart disease.Methods The application of various non-invasive examination techniques and related medical identification among aircrews with suspected coronary heart disease treated in Air Force Medical Center from January 2011 to July 2020 were analyzed respectively.Results As required by the study,71 clinical cases were included,all of whom underwent ECG and cardiac color Doppler ultrasound examination.Among these aircrews 69 underwent treadmill exercise test,63 underwent coronary artery CTA examination,10 were evaluated by CTFFR,9 underwent myocardial radionuclide scan,and 4 underwent cardiac magnetic resonance imaging.The results of coronary artery CTA combined with CTFFR were highly consistent with those of coronary angiography.Totally 36 aircrews were directly excluded from coronary artery stenosis through examination,27 of whom were qualified for flight.35 were diagnosed with coronary artery stenosis by examination,23 of whom were qualified for flight.Conclusion Proper use of non-invasive examination is of great value in the diagnosis and evaluation of suspected coronary heart diseases among military aircrews.Coronary artery CTA combined with CTFFR based on artificial intelligence technology has high accuracy in the diagnosis of coronary heart diseases,which can provide important data for further flight identification.