Purpose: The diagnosis and management of cardiovascular diseases are important for pilots, as well as the assessment of workload. Heart rate variability (HRV) can be evaluated from electrocardiography (ECG) signals during flight phases to assess the activation of the autonomic nervous system. Methods: In this study, continuous ECG activity was recorded of one pilot who flied as a pilot flying during a 4-hour long round trip using wearable ECG machine and was analyzed with MATLAB (R2020b ver. 9.9, The Mathworks Inc.). Total flight was divided into five phases: preflight, take off, cruise, landing, and postflight. Results: Mean heart rate (HR) was lowest in the postflight phase (76 bpm), and highest in the landing phase (86 bpm). Landing phase showed the highest values in standard deviation of NN interval (59.3 ms), triangular index (11.7), and triangular interpolation of NN interval (195 ms), while the postflight phase had highest root mean square of successive difference (20.5 ms) and proportion of successive RR interval (3.4 ms). As for frequency-domain metrics, the landing phase had the highest lowfrequency/high-frequency ratio of 5.33. Among the non-linear HRV measures, the landing phase presented the lowest SD1/SD2 ratio (0.15). Conclusion We observed the relative increase of mean HR and change of HRV in the landing phase, indicating elevated sympathetic nervous tone. Further studies should be considered to evaluate specific changes of ECG signals in flight phases and confirm the clinical use of the MATLAB signal analysis tools.

Purpose: The diagnosis and management of cardiovascular diseases are important for pilots, as well as the assessment of workload. Heart rate variability (HRV) can be evaluated from electrocardiography (ECG) signals during flight phases to assess the activation of the autonomic nervous system. Methods: In this study, continuous ECG activity was recorded of one pilot who flied as a pilot flying during a 4-hour long round trip using wearable ECG machine and was analyzed with MATLAB (R2020b ver. 9.9, The Mathworks Inc.). Total flight was divided into five phases: preflight, take off, cruise, landing, and postflight. Results: Mean heart rate (HR) was lowest in the postflight phase (76 bpm), and highest in the landing phase (86 bpm). Landing phase showed the highest values in standard deviation of NN interval (59.3 ms), triangular index (11.7), and triangular interpolation of NN interval (195 ms), while the postflight phase had highest root mean square of successive difference (20.5 ms) and proportion of successive RR interval (3.4 ms). As for frequency-domain metrics, the landing phase had the highest lowfrequency/high-frequency ratio of 5.33. Among the non-linear HRV measures, the landing phase presented the lowest SD1/SD2 ratio (0.15). Conclusion We observed the relative increase of mean HR and change of HRV in the landing phase, indicating elevated sympathetic nervous tone. Further studies should be considered to evaluate specific changes of ECG signals in flight phases and confirm the clinical use of the MATLAB signal analysis tools.

Purpose: The diagnosis and management of cardiovascular diseases are important for pilots, as well as the assessment of workload. Heart rate variability (HRV) can be evaluated from electrocardiography (ECG) signals during flight phases to assess the activation of the autonomic nervous system. Methods: In this study, continuous ECG activity was recorded of one pilot who flied as a pilot flying during a 4-hour long round trip using wearable ECG machine and was analyzed with MATLAB (R2020b ver. 9.9, The Mathworks Inc.). Total flight was divided into five phases: preflight, take off, cruise, landing, and postflight. Results: Mean heart rate (HR) was lowest in the postflight phase (76 bpm), and highest in the landing phase (86 bpm). Landing phase showed the highest values in standard deviation of NN interval (59.3 ms), triangular index (11.7), and triangular interpolation of NN interval (195 ms), while the postflight phase had highest root mean square of successive difference (20.5 ms) and proportion of successive RR interval (3.4 ms). As for frequency-domain metrics, the landing phase had the highest lowfrequency/high-frequency ratio of 5.33. Among the non-linear HRV measures, the landing phase presented the lowest SD1/SD2 ratio (0.15). Conclusion We observed the relative increase of mean HR and change of HRV in the landing phase, indicating elevated sympathetic nervous tone. Further studies should be considered to evaluate specific changes of ECG signals in flight phases and confirm the clinical use of the MATLAB signal analysis tools.

Purpose: The diagnosis and management of cardiovascular diseases are important for pilots, as well as the assessment of workload. Heart rate variability (HRV) can be evaluated from electrocardiography (ECG) signals during flight phases to assess the activation of the autonomic nervous system. Methods: In this study, continuous ECG activity was recorded of one pilot who flied as a pilot flying during a 4-hour long round trip using wearable ECG machine and was analyzed with MATLAB (R2020b ver. 9.9, The Mathworks Inc.). Total flight was divided into five phases: preflight, take off, cruise, landing, and postflight. Results: Mean heart rate (HR) was lowest in the postflight phase (76 bpm), and highest in the landing phase (86 bpm). Landing phase showed the highest values in standard deviation of NN interval (59.3 ms), triangular index (11.7), and triangular interpolation of NN interval (195 ms), while the postflight phase had highest root mean square of successive difference (20.5 ms) and proportion of successive RR interval (3.4 ms). As for frequency-domain metrics, the landing phase had the highest lowfrequency/high-frequency ratio of 5.33. Among the non-linear HRV measures, the landing phase presented the lowest SD1/SD2 ratio (0.15). Conclusion We observed the relative increase of mean HR and change of HRV in the landing phase, indicating elevated sympathetic nervous tone. Further studies should be considered to evaluate specific changes of ECG signals in flight phases and confirm the clinical use of the MATLAB signal analysis tools.

Purpose: The diagnosis and management of cardiovascular diseases are important for pilots, as well as the assessment of workload. Heart rate variability (HRV) can be evaluated from electrocardiography (ECG) signals during flight phases to assess the activation of the autonomic nervous system. Methods: In this study, continuous ECG activity was recorded of one pilot who flied as a pilot flying during a 4-hour long round trip using wearable ECG machine and was analyzed with MATLAB (R2020b ver. 9.9, The Mathworks Inc.). Total flight was divided into five phases: preflight, take off, cruise, landing, and postflight. Results: Mean heart rate (HR) was lowest in the postflight phase (76 bpm), and highest in the landing phase (86 bpm). Landing phase showed the highest values in standard deviation of NN interval (59.3 ms), triangular index (11.7), and triangular interpolation of NN interval (195 ms), while the postflight phase had highest root mean square of successive difference (20.5 ms) and proportion of successive RR interval (3.4 ms). As for frequency-domain metrics, the landing phase had the highest lowfrequency/high-frequency ratio of 5.33. Among the non-linear HRV measures, the landing phase presented the lowest SD1/SD2 ratio (0.15). Conclusion We observed the relative increase of mean HR and change of HRV in the landing phase, indicating elevated sympathetic nervous tone. Further studies should be considered to evaluate specific changes of ECG signals in flight phases and confirm the clinical use of the MATLAB signal analysis tools.

Background and Objectives: Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation. Methods: We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018. Results: Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies. The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p<0.001), while those of TMT, SPECT, and direct ICA have decreased (p<0.001, p=0.03, and p<0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p<0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p<0.001) and CABG (3.5% vs. 1.0%; p<0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p<0.001). Conclusions Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD.

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.