Medical appraisal of Chinese military aircrew with abnormal results of coronary computed tomographic angiography

Table 1 Aircraft type, battle station and age distribution of 15 flying personnel with abnormal results of coronary artery computed tomographic angiography

Aircraft type (aviation duty)		n	Proportion (%)	Age (year)	Median age (year)	Flying time (hour)
Pilot	Fighter	1	6.7	40	40.0	1800
	Fighter plane (Bomber)	1	6.7	47	47.0	3000
	Bomber	1	6.7	49	49.0	3200
	Transport plane	2	13.3	48-55	51.5 ± 4.9	5000-5600
	Primary trainer	1	6.7	49	49.0	3000
	Helicopter	3	20.0	48-51	50.0 ± 1.7	2600-3100
Navigator		1	6.7	50	50.0	4000
Air combat service worker		5	33.3	42-56	52.0 ± 5.8	2100-5000

Table 2 Comparison of age, flying time and flying duties between the two groups of aircrew

Group	n	Pilot, n (%)	Age (year)	Flying time (hour)
Single vessel disease group	6	1 (16.7)	49.0 ± 4.9	3850 ± 1282.7
Multi-vessel disease group	9	8 (88.9)	48.5 ± 4.7	3750 ± 1125.1
Statistical value			0.199	0.160
P value		0.011	0.845	0.876

Table 3 Results of laboratory tests between two groups

Group	n	Systolic blood pressure (mmHg)	Diastolic pressure (mmHg)	TC (mmol/L)	TG (mmol/L)	LDL-C (mmol/L)	ApoB (g/L)	Sum of IMT (mm)	Number of carotid plaques (%)
Single vessel disease group	6	134.5 ± 14.6	84.1± 9.4	4.3 ± 1.4	1.3 ± 0.6	3.0 ± 1.3	0.9 ± 0.4	4.3± 0.2	2 (33.3)
Multi-vessel disease group	9	122.5 ± 10.0	78.2± 9.5	5.9 ± 3.5	1.6± 0.3	4.2 ± 3.4	1.3± 0.7	4.0± 0.6	2 (22.2)

TC: Total cholesterol; TG: Triglyceride; LDL-C: Low-density lipoprotein cholesterol; Apo: Apolipoprotein; IMT: Intima-media thickness.

Table 4 Electrocardiogram, coronary artery computed tomographic angiography and flying appraisal conclusion of 15 aircrew with coronary artery diseases

Case	ECG	Coronary artery CTA	Coronary angiography	Flying appraisal conclusion
1	Biphase or low-flat T-wave in leads V4-V6	Small calcified plaques in the middle segment of both RCA and the posterior branch of left ventricle, without stenosis of the lumen, calcified plaques in the proximal segment of RCA, with slight stenosis of the corresponding lumen, and calcified plaques in the middle segment of LAD, with mild stenosis of the corresponding lumen		Qualified
2	Normal	Calcified plaques in the proximal segment of RCA, with slight stenosis of the corresponding lumen, and calcified plaques in the middle segment of LAD, with slight stenosis of the corresponding lumen		Qualified
3	Low-flat T-wave in leads V5 and V6	Soft plaques in the proximal segment of RCA, with local mild stenosis of the lumen, mixed plaques in the proximal segment of LAD, with local mild stenosis of the lumen, and calcified plaques in the proximal segment of LCX, with local mild stenosis of the lumen	Suggested to undergo coronary angiography	Unqualified for specially permitted flying of overage pilots
4	Normal	Calcified plaques in the middle segment of LAD, with mild stenosis of the lumen, superficial myocardial bridge formation in its distal segment, and calcified plaques in the proximal and middle segments of D1 and D2, with mild stenosis of the lumen	LAD: Myocardial bridge in the middle segment, with stenosis of 40%-50% in systole, TIMI3. LCX: Stenosis of 40% of the junction between the proximal and distal segments, TIMI3. RCA: Slight stenosis of the middle segment, with rough wall, indicating the changes of arteriosclerosis, TIMI3	Qualified
5	Normal	Soft plaques in the proximal segment of RCA, with mild stenosis of the corresponding lumen, soft plaques in the proximal segments of LAD, with mild stenosis of the corresponding lumen, and calcified plaques in the middle segment of LAD, with moderate stenosis of the corresponding lumen, and soft plaques in the proximal segments of LCX, with mild stenosis of the corresponding lumen	Suggested to undergo coronary angiography	Qualified
6	Abnormal q wave in side wall	(1) Calcified plaques in the proximal and middle segments of LAD, with local moderate stenosis (50%-70%) and distal myocardial bridge; (2) Severe stenosis of intermediate branch and mild stenosis in the proximal segment of circumflex branch (30%); (3) Mild stenosis of RCA (< 50%)	LM: No abnormalities. LAD: Continuous calcification in the proximal and middle segments, with the most severe stenosis above 85%, TIMI3, a FFR value of 0.59 (normal FFR > 0.75). LCX: Thick high OM, with CTO after originating from the proximal segment, and the distal segment supplied with blood through the collateral branch. RCA: Stenosis of about 50% of the proximal lumen after opening, TIMI3	Temporarily unqualified for flying
7	T wave changes in leads II, III, avF and V3-6	Mixed plaques in the first diagonal branch of the anterior descending branch, with slight stenosis of the lumen		Qualified
8	Sinus bradycardia	Soft plaques in the proximal segment of RCA, with mild stenosis of the lumen		Qualified
9	Low-flat T wave in leads V5 and V6	Calcified plaques in the proximal segment of LAD, with slight stenosis of the corresponding lumen (< 25%)		Qualified
10	Low-flat T wave in leads V4-6	Superficial myocardial bridge formed in the middle segment of LAD, with slight stenosis of the lumen (20%)		Qualified
11	Low-flat T wave in leads V4-6	Local mild and moderate stenosis of the proximal segment of LAD, with possibility of soft plaque formation		Qualified
12	Low-flat or inverted T wave in leads II, III and avF	High-density calcified plaques in the proximal segment of LAD, with mild stenosis of the lumen		Qualified
13	Grade I atrioventricular block and left ventricular hypertrophy accompanied with mild strain	Chest CT showed calcified plaques in coronary artery. Coronary artery CTA suggested calcified plaques in the middle segment of LAD, with slight stenosis of the lumen. Small calcified plaques in D2 segment, with slight stenosis of the lumen, and small calcified plaques in middle and distal segments of LCX, with slight stenosis of the lumen	LAD: Stenosis of 50%, TIMI3, FFR 0.91. LM(-), LCX(-) and RCA: Abnormally thick lumen, TIMI3	Unqualified for specially permitted flying of overage pilots
14	Normal	Chest CT showed multiple calcified plaques in coronary artery. Coronary artery CTA indicated mixed plaques in the proximal segment, calcified plaques in the middle and soft plaques in the distal segment of RCA, with mild to moderate stenosis of the lumen. Mixed plaques in LM, with mild stenosis of the lumen. Mixed plaques in the proximal and middle segments of LAD, with mild to moderate stenosis of the lumen. Mixed plaques in the proximal segment of LCX, with mild stenosis of the lumen. Mixed plaques in the proximal and middle segments of OM, with mild to moderate stenosis of the lumen	LM(-): Presence of IB, with stenosis of 60% in IB opening. LAD: Calcification shadow in the proximal segment, stenosis of 30%-40% in the proximal and middle segments, myocardial bridge in the middle segment, with stenosis in systole, TIMI3. LCX(-) and OM: Thick. OM2: Beaded stenosis of 50%-80% in the proximal and middle segments, TIMI3, FFR 0.78. RCA: Stenosis of about 50% in the proximal and middle segments, focal stenosis of 50% in the middle segment, stenosis of 40%-50% in the middle and distal segments, eccentric stenosis of 80% in the distal segment, presence of PDA and PL, TIMI3, FFR 0.77	Unqualified for specially permitted flying of overage pilots
15	Sinus bradycardia with low-flat T wave (V5V6)	Coronary artery calcification score: 229 points. Coronary artery CTA showed calcified plaques in the proximal and middle segments of RCA, with mild stenosis of the lumen, soft plaques in the proximal segment of LAD, with mild stenosis of the lumen, superficial myocardial bridge in the middle and distal segments, without stenosis of the lumen, calcification at the proximal end of D1, without stenosis of the lumen	LM(-) and LAD: Stenosis of 50% in the proximal segment, myocardial bridge in the middle and distal segments, stenosis of about 20% in systole, stenosis of about 30% of D1 opening, TIMI3. LCX: Presence of high OM originating the proximal segment, tiny PL in the distal segment, TIMI3. RCA: Thick lumen, and two focal plaques in the middle and distal segments, with stenosis of 30%, thick PDA and PL, with TIMI3	Unqualified for specially permitted flying of overage pilots

CTA: Computed tomographic angiography; TIMI: Thrombolysis in myocardial infarction; FFR: Fractional flow reserve; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; OM: Obtuse marginal branch; CTO: Chronic total occlusion; IB: Irregular branch; PDA: Posterior descending artery; PL: Posterior branch of left ventricle; ECG: Electrocardiogram; RCA: Right coronary artery; CT: Computed tomography; LM: Left main coronary artery.