3D-Cardiovascular Cartography: A Novel Non-invasive Technique for Coronary Screening in Aircrew

Cardiovascular screening to exclude coronary artery disease (CAD) forms a very important part of any aircrew evaluation. A routine ECG forms part of initial evaluation for aircrew duties. As the incidence of CAD is age-related, repeat ECG examination and even periodic Bruce protocol stress test are mandatory requirements by certain Regulatory Agencies including India. Routine use of cardiac stress testing has been controversial because of inadequate specificity when applied to an asymptomatic population. At times further invasive tests for delineation of the coronary arteries become necessary with avoidable stress and even risk to life to the apparently normal aircrew. Availability of population health data and increasing use of computer applications in medical database management have made risk analysis and risk stratification easier and more reliable. This paper discusses the use of a truly non-invasive protocol for routine coronary screening, especially of aircrew. The first part of the protocol involves the use of a simple computer-based algorithm developed using the Framingham study with various risk factors including age, gender, family history, smoking habit, body mass index, blood pressure, cholesterol and HDL levels. The software predicts the coronary risk of the individual based on population data. The second part of the protocol involves the use of a novel new technique of 3-D Cardiovascular Cartography (CCG). This is based on 3-D mathematical modeling and simulation using high speed computation enabling non-linear haemodynamics to be evaluated from beat-to-beat recording of the cardiac cycle. The regional coronary circulation is displayed and a number of physiological data of cardiac functions are calculated. It is recommended that the scope of using these non-invasive methods in routine cardiovascular evaluation of the aircrew be considered. The data obtained by these techniques will also be useful in aircrew maintenance programmes based on preventive cardiology.