Author + information
- Eddie Davenport,
- Edwin Palileo,
- William Kruyer and
- Steven Gore
Background: The efficacy of cardiac screening programs for individuals in high-risk occupations such as commercial and military aviation is highly debated. In 2015, the United States Air Force (USAF) developed a new screening process based on data acquired over the last 60 years.
Methods: The USAF School of Aerospace Medicine's Clinical Sciences Database contains over 1.2 million cardiac studies on over 283,000 aviators since 1954. For this study 20,208 consecutive screening echocardiograms on pilot applicants were analyzed. Exercise stress tests with or without nuclear imaging and coronary calcium on fluoroscopy were also analyzed in 903 asymptomatic aviators with no known cardiovascular disease who underwent invasive coronary angiography.
Results: The most common diagnoses on screening echocardiograms were bicuspid aortic valve with mild or less aortic insufficiency (N =154, 0.76%), mitral valve prolapse with mild or less mitral regurgitation (N=51, 0.25%), and trileaflet aortic valve with mild aortic insufficiency (N=58, 0.29%). Only nine (0.045%) aviators were disqualified from flying duties based on echocardiogram diagnoses. Asymptomatic screening tests with exercise treadmill testing or treadmill testing with nuclear imaging yielded a positive predictive value of 16% and 21%, respectively, for coronary artery disease (aggregate stenosis >50% on invasive coronary angiography). The annual cardiac event rate (of death, myocardial infarction, or revascularization) was 0.5% for exercise and nuclear stress testing regardless of study outcome. Calcium seen on fluoroscopy yielded a 1.1% annual cardiac event rate and thus was the most predictive of coronary artery disease.
Conclusions: It is not efficacious to perform screening echocardiography or stress testing in asymptomatic individuals with no cardiac risk factors. Coronary calcium scoring is likely efficacious in this population if not low risk. A new evidence-based USAF screening algorithm for pilots in the USAF developed and approved in 2016 will be presented.
Room 140 B
Sunday, March 19, 2017, 9:04 a.m.-9:14 a.m.
Session Title: Highlighted Original Research: Non Invasive Imaging and the Year in Review
Abstract Category: 31. Non Invasive Imaging: Sports and Exercise
Presentation Number: 909-12
- 2017 American College of Cardiology Foundation