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Transthoracic Echocardiography for Evaluation of Isolated RSR Pattern in Military Aircrew Applicants
Introduction:
RSR pattern in precordial electrocardiogram (ECG) leads may represent various underlying cardiac conditions. While generally benign, there is insufficient evidence precluding the need for further echocardiographic assessment. This retrospective cohort study aims to investigate the utility of transthoracic echocardiography (TTE) in diagnosing disqualifying cardiac conditions among Republic of Singapore Air Force (RSAF) applicants with isolated RSR on pre-employment medical screening (PEMS).
Methods:
Applicants who underwent PEMS from December 31, 2014-December 31, 2024, had isolated ECG RSR with subsequent TTE, complete medical records, and clearly documented selection outcomes were identified from RSAF PEMS data. Data pertaining to baseline demographics, cardiovascular risk factors, cardiac investigation findings, and PEMS outcomes were extracted.
Results:
Of 102 eligible applicants, 95 accepted for all vocations and 7 disqualified from at least one vocation formed the accepted and disqualified cohorts, respectively. Overall, 18.6% (N = 19) of the cohort had abnormal TTE findings. Compared to the accepted cohort, the proportion of abnormal TTE (N = 6, 85.7% vs N = 13, 13.7%) was significantly higher in those disqualified. Regression analysis demonstrated significant correlation between abnormal TTE findings and QRS duration (OR = 1.12; CI = 1.03,1.20).
Discussion:
This study highlights the potential value of integrating ECG-based risk stratification with echocardiographic evaluation to balance diagnostic accuracy, resource efficiency, and mitigation of aeromedical risks. Nonetheless, TTE continues to be of value in identifying disqualifying cardiac conditions among individuals with isolated RSR during ab-initio military aviation selection in the RSAF. Yang WYL, Cheok LJ, Ching K, Koh CH, See B, Low JW. Transthoracic echocardiography for evaluation of isolated RSR pattern in military aircrew applicants. Aerosp Med Hum Perform. 2026; 97(6):403-410.
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