Echocardiography screening of German military pilot applicants as an example for high-hazard occupations

Introduction: Pre-employment screening is of utmost importance in high-risk occupations for the early diagnosis and prevention of cardiac and non-cardiac disease, and for risk mitigation. Recommendations for echocardiography screening, however, are contradictory. It was the aim of this study to retrospectively analyze echocardiography data from German military pilot applicant screening to find out in how many cases cardiac disease was diagnosed, and how often the diagnosis influenced aeromedical decision making. Methods: 6,110 screening echocardiographies from German military pilot applicants, 5,923 were male, examined between January 2007 and June 2020 were retrospectively analyzed for findings and their impact on aeromedical decisions. Results: During a 14.5-year period, 4,477 out of 6,110 screening echocardiograms were normal. The remaining 1,633 applicants revealed a total of 1,962 abnormalities, mainly consisting of minor tricuspid and mitral valve regurgitations (81.9%). Due to echocardiography findings, 80 applicants (1.3%) were unfit for flying duties, 9 (0.1%) were fit with limitations, and 1,544 (25.3%) were fit with findings that had to be monitored over time, but which were not aeromedically relevant. The most common diagnoses leading to disqualification or limitations were bicuspid aortic valve with or without aortic regurgitation (84.9%) and mitral valve prolapse with or without regurgitation (9.3%). Conclusion: Percentages of abnormal findings were similar to other studies. Aeromedical assessments based on those findings, however, were slightly different, as they depend on national employment policies. As a consequence, the usefulness of echocardiography may vary between different countries and different professions, depending on the acceptance of certain findings for employment.