Strader JR, Harrell TW, Adair A, Kruyer WB. Efficacy of echocardiographic screening of pilot applicants. Aviat Space Environ Med 2008; 79:514–7. Background: The efficacy of cardiac screening programs for individuals in competitive athletics and high-risk occupations such as commercial and military aviation continues to be highly debated. For the past 12 yr, all United States Air Force (USAF) pilot applicants have undergone screening echocardiography. Methods: All available studies were reviewed for disqualifying (DQ) diagnoses. Findings were analyzed and compared to current USAF waiver policy. Results: Between inception in March 1994 and 01 September 2006, there were 20,208 screening echocardiograms performed. Of these, 294 (1.45%) were initially read as disqualifying. The most common diagnoses were bicuspid aortic valves 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%). Evolution of USAF waiver policy has now rendered these diagnoses waiverable for entry into pilot training. Under current policy, 285/294 would be eligible for an unrestricted waiver, leaving only 9 individuals “DQ/no-waiver” (0.0445%). There were no cases of hypertrophic cardiomyopathy. Although the number of USAF pilot applicants has increased in recent years, the DQ/no-waiver rate has actually decreased, with only a single DQ/no-waiver finding since 2004 (N = 5802 studies; 0.0172%). Discussion: The infrequency of positive findings in this large cohort of screening echocardiography raises questions about the appropriateness of such programs. Under current USAF policy, it is not efficacious to perform screening echocardiography on all pilot applicants.