{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T03:18:00Z","timestamp":1782962280652,"version":"3.54.5"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1436805","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T11:27:36Z","timestamp":1741778856000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Echocardiography screening of German military pilot applicants as an example for high-hazard occupations"],"prefix":"10.3389","volume":"13","author":[{"given":"Norbert","family":"Guettler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Sammito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2389","DOI":"10.1093\/eurheartj\/ehz512","article-title":"An introduction to occupational cardiology","volume":"40","author":"Chamley","year":"2019","journal-title":"Eur Heart J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"s17","DOI":"10.1136\/heartjnl-2018-313053","article-title":"The challenge of asymptomatic coronary artery disease in aircrew; detecting plaque before the accident","volume":"105","author":"Gray","year":"2019","journal-title":"Heart"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"950","DOI":"10.3357\/AMHP.5985.2021","article-title":"Grounding of pilots: medical reasons and recommendations for prevention","volume":"92","author":"Simons","year":"2021","journal-title":"Aerosp Med Hum Perform"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1007\/s00420-013-0901-x","article-title":"Medical risks in older pilots: a systematic review on incapacitation and age","volume":"87","author":"Huster","year":"2014","journal-title":"Int Arch Occup Environ Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/eurjpc\/zwab202","article-title":"Cardiovascular risk in high-hazard occupations: the role of occupational cardiology","volume":"29","author":"Parsons","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12995-021-00327-x","article-title":"Electrocardiographic abnormalities in medically screened German military aircrew","volume":"16","author":"Guettler","year":"2021","journal-title":"J Occup Med Toxicol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"666","DOI":"10.3357\/AMHP.6051.2022","article-title":"Exercise ECG for screening in military aircrew","volume":"93","author":"Guettler","year":"2022","journal-title":"Aerosp Med Hum Perform"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1159\/000245936","article-title":"Screening echocardiography of military aircrew candidates: aeromedical implications","volume":"115","author":"Wand","year":"2010","journal-title":"Cardiology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1016\/S0735-1097(15)61454-1","article-title":"Screening with echocardiography or stress testing in asymptomatic USAF aviators \u2013 not efficacious","volume":"65","author":"Davenport","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"s3","DOI":"10.1136\/heartjnl-2018-313019","article-title":"An introduction to aviation cardiology","volume":"105","author":"Nicol","year":"2019","journal-title":"Heart"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"135","DOI":"10.3357\/asem.3474.2014","article-title":"Cardiac indexes in young subjects with and without bicuspid aortic valve","volume":"85","author":"Grossman","year":"2014","journal-title":"Aviat Space Environ Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"100242","DOI":"10.1016\/j.ahjo.2022.100242","article-title":"Relationship between arm span to height ratio, aortic root diameter, and systolic blood pressure in collegiate athletes","volume":"25","author":"Altman","year":"2022","journal-title":"Am Heart J Plus"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"i135","DOI":"10.1093\/ehjci\/jead119.089","article-title":"Focused echocardiographic screening of the aortic valve and aorta in elite rugby players","volume":"24","author":"Chatrath","year":"2023","journal-title":"Eur Heart J-Cardiovascular Imaging"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1093\/eurheartj\/ehab440","article-title":"Screening professional athletes for cardiovascular diseases at risk of cardiac arrest","volume":"43","author":"Corrado","year":"2022","journal-title":"Eur Heart J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"297","DOI":"10.2459\/JCM.0000000000001460","article-title":"Echocardiography in the preparticipation screening: an old topic revisited","volume":"24","author":"Donati","year":"2023","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1093\/eurjpc\/zwad287","article-title":"Cost-effectiveness and diagnostic accuracy of focused cardiac ultrasound in the pre-participation screening of athletes: the SPORT-FoCUS study","volume":"30","author":"Halasz","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1007\/s12551-023-01085-2","article-title":"Should young athletes be screened for cardiomyopathies to reduce the burden of sudden cardiac death in athletes?","volume":"15","author":"McColgan","year":"2023","journal-title":"Biophys Rev"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"271","DOI":"10.4330\/wjc.v13.i8.271","article-title":"Potential role of an athlete-focused echocardiogram in sports eligibility","volume":"13","author":"Palermi","year":"2021","journal-title":"World J Cardiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1177\/2047487320932018","article-title":"The use of cardiac imaging in the evaluation of athletes in the clinical practice: a survey by the sports cardiology and exercise section of the European Association of Preventive Cardiology and University of Siena, in collaboration with the European Association of Cardiovascular Imaging, the European heart rhythm association and the ESC working group on myocardial and pericardial diseases","volume":"28","author":"D'Ascenzi","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"100119","DOI":"10.1016\/j.shj.2022.100119","article-title":"The natural history of bicuspid aortic valve disease","volume":"7","author":"Kusner","year":"2022","journal-title":"Struct Heart"},{"key":"ref21","volume-title":"Wehrfliegerverwendungsf\u00e4higkeit und weitere Tauglichkeitsuntersuchungen von Luftfahrtpersonal","year":"2024"},{"key":"ref22","volume-title":"Aerospace medicine waiver guide","year":"2022"},{"key":"ref23","volume-title":"Wehrmedizinische Begutachtung. A1-831\/0\u20134000. Version 4","year":"2024"},{"key":"ref24","volume-title":"Acceptable means of compliance and guidance material to part-MED","year":"2019"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"455","DOI":"10.3390\/jcm11020455","article-title":"Diagnosis of mitral valve prolapse: much more than simple prolapse. Multimodality approach to risk stratification and therapeutic management","volume":"11","author":"Alenazy","year":"2022","journal-title":"J Clin Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1056\/NEJM198511213132101","article-title":"Echocardiographically documented mitral-valve prolapse. Long-term follow-up of 237 patients","volume":"313","author":"Nishimura","year":"1985","journal-title":"N Engl J Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1136\/heartjnl-2017-312932","article-title":"Mitral valve prolapse and sudden cardiac death: a systematic review and meta-analysis","volume":"105","author":"Nalliah","year":"2029","journal-title":"Heart"},{"key":"ref28","volume-title":"Sudden cardiac death; report of a WHO scientific group","year":"1985"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1161\/CIRCULATIONAHA.115.016291","article-title":"Arrhythmic mitral valve prolapse and sudden cardiac death","volume":"132","author":"Basso","year":"2015","journal-title":"Circulation"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1436805\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T11:27:39Z","timestamp":1741778859000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1436805\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,12]]},"references-count":29,"alternative-id":["10.3389\/fpubh.2025.1436805"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1436805","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,12]]},"article-number":"1436805"}}