Investigation on the effect of myocardial bridge on ventricular repolarization in civil pilots
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目的 调查民航飞行员心肌桥的检出情况及心肌桥飞行员心室复极是否存在异常，探讨心肌桥对心室复极的影响。 方法 采用回顾性研究，分析2019年≥40岁的民航飞行员次极量平板运动试验资料。排除患有影响心室复极的心血管疾病者。测定飞行员运动前静息心电图及运动结束后1 min QT间期，计算QT间期离散度（QT dispersion，QTd）。根据是否检出心肌桥分为心肌桥组和对照组，对比分析心肌桥组与对照组飞行员的平板运动试验阳性率及室性早搏发生率。对行24 h动态心电图检查者，统计分析QT/RR斜率。 结果 共有243例飞行员纳入研究，其中男性242例，女性1例。243例民航飞行员中检出心肌桥27例，主要见于左冠状动脉前降支（25/27，92.6%）；17例行24 h动态心电图检查，其中心肌桥组6例，对照组11例。心肌桥组飞行员总飞行时间多于对照组，差异有统计学意义（Z=2.29，P=0.022）；次极量平板运动试验的阳性率或可疑阳性率及室性早搏的发生率均高于对照组，差异有统计学意义（χ2=52.74、5.78，P<0.001、=0.016）；平板运动试验恢复1 min后QTd延长大于对照组，差异有统计学意义（Z=-2.20，P=0.028）；24 h室性早搏的平均发生次数、QTe/RR斜率和QTa/RR斜率高于对照组，差异均有统计学意义（t=2.37、4.26、2.51，P=0.034、<0.001、=0.024）。 结论 飞行员心肌桥可能导致心室复极时间延长，易发生室性心律失常。平时航空卫生保障工作中应重视心肌桥飞行员的体检和飞行适应性评定，尤其要加强对心室复极异常飞行员的日常健康管理，以确保飞行安全。 Objective To investigate the detection of myocardial bridge in civil aviation pilots and whether there is abnormal ventricular repolarization in the pilots with myocardial bridge, and to explore the effect of myocardial bridge on ventricular repolarization. Methods Retrospective study was used to analyze the data of submaximal treadmill exercise test in 2019 for the civil aviation pilots aged ≥40. Pilots with cardiovascular diseases affecting ventricular repolarization were excluded. The resting electrocardiogram before exercise and 1 min QT interval after exercise were measured, and the QT dispersion (QTd) was calculated. The pilots were divided into myocardial bridge group and control group according to whether myocardial bridge was detected. The positive rate of treadmill exercise test and the incidence of ventricular extrasystole were compared between the pilots in myocardial bridge group and control group. The QT/RR slope was statistically analyzed in the pilots received 24 h electrocardiogram monitoring. Results A total of 243 pilots were enrolled, including 242 males and 1 female. Among the 243 cases, 27 cases of myocardial bridge pilots were detected, and the myocardial bridge was mainly found in the anterior descending branch of left coronary artery (25/27, 92.6%). The 24 h dynamic electrocardiogram was examined in 17 cases, 6 cases were in the myocardial bridge group and 11 cases were in the control group. The total flying hours of the myocardial bridge group was longer than that of the control group (Z=2.29, P=0.022) the positive rate or suspected positive rate of submaximal treadmill exercise test and the incidence of ventricular extrasystole in the myocardial bridge group were higher than those in the control group, and the differences were significant (χ2=52.74, 5.78, P<0.001, =0.016) the 1 min QTd in the convalescent phase of the treadmill exercise test in the myocardial bridge group was longer than that in the control group, and the difference was significant (Z=-2.20, P=0.028). The average frequency of 24 h ventricular extrasystole, QTe/RR slope and QTa/RR slope in the myocardial bridge group were higher than those in the control group, and the differences were significant (t=2.37, 4.26, 2.51, P=0.034, <0.001, =0.024). Conclusions Pilots with myocardial bridge may have prolonged ventricular repolarization and are prone to ventricular arrhythmias. In order to ensure flight safety, attention should be paid to the physical examination and flight adaptability evaluation of the pilots with myocardial bridge, especially to strengthen daily health management of the pilots with ventricular repolarization abnormalities.
Objective To investigate the detection of myocardial bridge in civil aviation pilots and whether there is abnormal ventricular repolarization in the pilots with myocardial bridge, and to explore the effect of myocardial bridge on ventricular repolarization. Methods Retrospective study was used to analyze the data of submaximal treadmill exercise test in 2019 for the civil aviation pilots aged ≥40. Pilots with cardiovascular diseases affecting ventricular repolarization were excluded. The resting electrocardiogram before exercise and 1 min QT interval after exercise were measured, and the QT dispersion (QTd) was calculated. The pilots were divided into myocardial bridge group and control group according to whether myocardial bridge was detected. The positive rate of treadmill exercise test and the incidence of ventricular extrasystole were compared between the pilots in myocardial bridge group and control group. The QT/RR slope was statistically analyzed in the pilots received 24 h electrocardiogram monitoring. Results A total of 243 pilots were enrolled, including 242 males and 1 female. Among the 243 cases, 27 cases of myocardial bridge pilots were detected, and the myocardial bridge was mainly found in the anterior descending branch of left coronary artery (25/27, 92.6%). The 24 h dynamic electrocardiogram was examined in 17 cases, 6 cases were in the myocardial bridge group and 11 cases were in the control group. The total flying hours of the myocardial bridge group was longer than that of the control group (Z=2.29, P=0.022) the positive rate or suspected positive rate of submaximal treadmill exercise test and the incidence of ventricular extrasystole in the myocardial bridge group were higher than those in the control group, and the differences were significant (χ2=52.74, 5.78, P<0.001, =0.016) the 1 min QTd in the convalescent phase of the treadmill exercise test in the myocardial bridge group was longer than that in the control group, and the difference was significant (Z=-2.20, P=0.028). The average frequency of 24 h ventricular extrasystole, QTe/RR slope and QTa/RR slope in the myocardial bridge group were higher than those in the control group, and the differences were significant (t=2.37, 4.26, 2.51, P=0.034, <0.001, =0.024). Conclusions Pilots with myocardial bridge may have prolonged ventricular repolarization and are prone to ventricular arrhythmias. In order to ensure flight safety, attention should be paid to the physical examination and flight adaptability evaluation of the pilots with myocardial bridge, especially to strengthen daily health management of the pilots with ventricular repolarization abnormalities.
Ventricular premature complexesCoronary diseasesExercise testVentricular repolarizationCivil pilots
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