{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T02:39:32Z","timestamp":1777084772474,"version":"3.51.4"},"reference-count":24,"publisher":"Aerospace Medical Association","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>\n                    <jats:bold>INTRODUCTION:<\/jats:bold>\n                    Heart muscle diseases are challenging for the aeromedical examiner due to their heterogeneous nature and widely varying natural history. The diagnosis of heart muscle disease is likely to have a significant impact on flying privileges, with the risk assessment requiring careful testing and careful follow up. Consideration must also be given to the treatments used in each individual, as these may also pose an aeromedical risk. In athletic aircrew, differentiating athletic adaptation from a cardiomyopathy is essential to decide if flying restrictions are necessary.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>CASE PRESENTATION:<\/jats:bold>\n                    This article provides insights into the appropriate investigation of aircrew with suspected or proven heart muscle disease, to assist with licensing decisions. Four case vignettes are presented (myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, and athletic heart) to give a broad overview of the commonest areas of heart muscle disease seen in aircrew. The relevant features of evaluation, treatment, and aeromedical relevance are provided in a brief discussion of each case.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>DISCUSSION:<\/jats:bold>\n                    This paper presents the most current recommendations for assessing aircrew with heart muscle disease and cardiomyopathy with data derived from current aeromedical and clinical literature, as well as the expert consensus of the NATO Working Groups on Occupational Cardiology (HFM WG 251, 316)\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      D\u2019Arcy J, Syburra T, Broekhuizen L, Holdsworth D, Guettler N, Bron D, Manen O, Davenport E.\n                      <jats:italic>Structural heart disease in aircrew<\/jats:italic>\n                      . Aerosp Med Hum Perform. 2026; 97(2):116\u2013122.\n                    <\/jats:bold>\n                  <\/jats:p>","DOI":"10.3357\/amhp.6676.2026","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T13:44:32Z","timestamp":1770731072000},"page":"116-122","source":"Crossref","is-referenced-by-count":0,"title":["Structural Heart Disease in Aircrew"],"prefix":"10.3357","volume":"97","author":[{"given":"Joanna","family":"D\u2019Arcy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Syburra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lysette","family":"Broekhuizen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Holdsworth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Guettler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis","family":"Bron","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Manen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eddie","family":"Davenport","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1911","reference":[{"issue":"5","key":"B1","series-title":"J Am Coll Cardiol.","first-page":"697","article-title":"Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy","volume":"45","author":"Adabag AS","year":"2005","unstructured":"Adabag AS, Casey SA, Kuskowski MA, Zenovich AG, Maron BJ. Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005; 45(5):697\u2013704."},{"issue":"2","key":"B2","series-title":"Genet Couns.","first-page":"107","article-title":"Penetrance of familial hypertrophic cardiomyopathy","volume":"8","author":"Charron P","year":"1997","unstructured":"Charron P, Carrier L, Dubourg O, Tesson F, Desnos M,  Penetrance of familial hypertrophic cardiomyopathy. Genet Couns. 1997; 8(2):107\u201314."},{"key":"B3","series-title":"Heart.","first-page":"s50","article-title":"Heart muscle disease management in aircrew","volume":"105","author":"D\u2019Arcy JL","year":"2019","unstructured":"D\u2019Arcy JL, Manen O, Davenport ED, Syburra T, Rienks R,  Heart muscle disease management in aircrew. Heart. 2019 Jan; 105(Suppl 1):s50\u20136."},{"issue":"3","key":"B4","series-title":"Eur J Heart Fail.","first-page":"323","article-title":"Frequency, prognosis and predictors of improvement of systolic left ventricular function in patients with \u2018classical\u2019 clinical diagnosis of idiopathic dilated cardiomyopathy","volume":"3","author":"Cicoira M","year":"2001","unstructured":"Cicoira M, Zanolla L, Latina L, Rossi A, Golia G,  Frequency, prognosis and predictors of improvement of systolic left ventricular function in patients with \u2018classical\u2019 clinical diagnosis of idiopathic dilated cardiomyopathy. Eur J Heart Fail. 2001 Jun; 3(3):323\u201330."},{"key":"B5","series-title":"Circulation.","first-page":"564","article-title":"Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. a population-based study in Olmsted County, Minnesota, 1975-1984","volume":"80","author":"Codd MB","year":"1989","unstructured":"Codd MB, Sugrue DD, Gersh BJ, Melton LJ. Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. a population-based study in Olmsted County, Minnesota, 1975-1984. Circulation. 1989 Sep; 80(3):564\u201372."},{"issue":"21","key":"B6","series-title":"Eur Heart J.","first-page":"2599","article-title":"Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy","volume":"30","author":"Gimeno JR","year":"2009","unstructured":"Gimeno JR, Tom\u00e9-Esteban M, Lofiego C, Hurtado J, Pantazis A,  Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy. Eur Heart J. 2009 Nov; 30(21):2599\u2013605."},{"key":"B7","series-title":"J Am Coll Cardiol.","first-page":"1964","article-title":"Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis","volume":"70","author":"Gr\u00e4ni C","year":"2017","unstructured":"Gr\u00e4ni C, Eichhorn C, Bi\u00e8re L, Murthy VL, Agarwal V,  Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. J Am Coll Cardiol. 2017 Oct 17; 70(16):1964\u201376."},{"issue":"8","key":"B8","series-title":"Aviat Space Environ Med.","first-page":"688","article-title":"Arrhythmias observed during high-G training: proposed safety training criterion","volume":"75","author":"Hanada R","year":"2004","unstructured":"Hanada R, Hisada T, Tsujimoto T, Ohashi K. Arrhythmias observed during high-G training: proposed safety training criterion. Aviat Space Environ Med. 2004 Aug; 75(8):688\u201391."},{"issue":"1","key":"B9","series-title":"J Cardiovasc Magn Reson.","first-page":"48","article-title":"Cardiac MRI improves cardiovascular risk stratification in hazardous occupations","volume":"21","author":"Holdsworth DA","year":"2019","unstructured":"Holdsworth DA, Parsons IT, Chamley R, Britton J, Pavitt C,  Cardiac MRI improves cardiovascular risk stratification in hazardous occupations. J Cardiovasc Magn Reson. 2019 Jul 29; 21(1):48."},{"issue":"10","key":"B10","series-title":"N Engl J Med.","first-page":"690","article-title":"Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis","volume":"342","author":"McCarthy RE","year":"2000","unstructured":"McCarthy RE 3rd, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK,  Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. 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Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. a population-based study in Olmsted County, Minnesota, 1975-1984. Circulation. 1989 Sep; 80(3):564\u201372."},{"issue":"21","key":"B6","series-title":"Eur Heart J.","first-page":"2599","article-title":"Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy","volume":"30","author":"Gimeno JR","year":"2009","unstructured":"Gimeno JR, Tom\u00e9-Esteban M, Lofiego C, Hurtado J, Pantazis A,  Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy. 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Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients. 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