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.
18.6% of military aircrew applicants with isolated RSR pattern had abnormal transthoracic echocardiography findings.
The proportion of abnormal TTE findings was significantly higher in disqualified applicants compared to accepted applicants.
QRS duration was significantly correlated with abnormal TTE findings on regression analysis.
The study suggests integrating ECG-based risk stratification with echocardiographic evaluation to balance diagnostic accuracy, resource efficiency, and aeromedical risk mitigation.
This research studied whether heart ultrasound (echocardiography) is useful for evaluating a specific electrocardiogram (ECG) pattern called 'RSR' in people applying to be military aircrew in Singapore. The RSR pattern is a particular electrical pattern seen on an ECG that can sometimes indicate heart problems, but is often harmless. Researchers looked at 10 years of screening data from 102 applicants who had this ECG pattern and also received a heart ultrasound as part of their medical evaluation. The study found that nearly 1 in 5 applicants (18.6%) with this ECG pattern had abnormal heart ultrasound results. More importantly, among the 7 applicants who were disqualified from at least one flight role, 85.7% had abnormal ultrasound findings, compared to only 13.7% of those who were accepted. The study also found that the duration of a specific part of the ECG reading (called QRS duration) was statistically linked to having an abnormal ultrasound, suggesting it could help identify who most needs further testing. This research suggests that heart ultrasound remains a valuable screening tool for detecting potentially disqualifying heart conditions in military aviation applicants who show this ECG pattern. It also suggests that combining ECG measurements — particularly QRS duration — with ultrasound evaluation could help medical screening programs make more targeted and resource-efficient decisions about who needs further cardiac workup, which is especially important in high-stakes occupational settings like military aviation.
Yang W, Cheok L, Ching K, Koh C, See B, Low J. (2026). Transthoracic Echocardiography for Evaluation of Isolated RSR Pattern in Military Aircrew Applicants.. Aerospace medicine and human performance. https://doi.org/10.3357/AMHP.6742.2026