Regurgitant valvular disease prevalence and progression found on echocardiogram in military aviators

Introduction: The prevalence, progression rates, and outcomes affecting aviator valvular heart disease have not been extensively studied. Methods: The U.S. Air Force (USAF) School of Aerospace Medicine' s Clinical Sciences Database was used to determine prevalence and progression rates for regurgitant valvular disease. A subset of the initial population was further evaluated for risk factors that increased the likelihood of progression. Descriptive statistical analysis, analysis of variance, and t-test calculations were completed. Results: There were 8475 unique aviators with some degree of valvular regurgitation for an overall prevalence of 3.0%. The mitral and aortic valves were most likely to have mild and moderate or greater regurgitation, respectively. Progression rates from mild to moderate were 8% in the aortic valve, 2% in the mitral valve, and less than 1% in the pulmonic and tricuspid valves. Progression rates from moderate to severe were over 20% for both the mitral and aortic valves. The only risk factors correlating to progression of valvular disease were lower levels of high-density lipoproteins in the mitral and aortic valves and triglycerides in the mitral valve. Discussion: In USAF aviators, progression rates for mild or greater aortic valve regurgitation and moderate or greater mitral valve regurgitation are significant and should be followed closely. Classic risk factors of age, tobacco use, elevated blood pressure, and hyperlipidemia have no association with increased risk of valvular progression or rate of progression. Study outcomes validate the current USAF policy for valvular heart disease in aviators.