Echocardiographic Screening of the General Population and Long-term Survival

Abstract

dentification of structural heart disease in asymptomatic individuals could allow early disease-modifying treatment. Echocardiography is frequently used to evaluate low-risk individuals, and there is an increasing interest in cardiovascular screening because of public awareness of unexplained cardiac deaths among adults and athletes. 1-3 Because of the low prevalence of structural heart disease among the general population, echocardiography has traditionally not been considered justified in low-risk individuals, although it is recommended in screening asymptomatic individuals with a family history of sudden death or hereditary diseases affecting the heart or the great vessels. 4-6 In the present study, we examined whether echocardiographic screening for structural heart disease in the general population improves long-term survival or reduces the risk of cardiovascular disease. Methods Study Population The Tromsø Study is a population-based, prospective cohort study conducted in the municipality of Tromsø, Norway. It was initiated in 1974, with a focus on cardiovascular disease. The study design includes repeated population health surveys, to which selected birth cohorts and random samples of other cohorts were invited. The study population comprises a homogeneous population of white race/ethnicity. All inhabitants 25 years or older were invited to the fourth survey (1994-1995). Of the eligible persons, 27 159 (77.0%) attended the first visit. All individuals aged 55 to 74 years and random 5% to 10% samples of the other age groups (aged 25-54 and 75-85 years) were invited to a second visit for more extensive examina-IMPORTANCE Identification of structural heart disease in asymptomatic individuals could allow early disease-modifying treatment. OBJECTIVE To examine whether echocardiographic screening in the general population improves long-term survival or reduces the risk of cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS We studied 6861 middle-aged participants from the population-based Tromsø Study in Norway. INTERVENTION Participants were randomly allocated to an echocardiographic screening group (n = 3272) or a control group (n = 3589). MAIN OUTCOMES AND MEASURES Using the as-treated approach, the data were analyzed for mortality and incidence of fatal and nonfatal myocardial infarction and stroke. RESULTS During 15 follow-up years, 880 persons (26.9%) in the screening group and 989 persons (27.6%) in the control group died (hazard ratio, 0.97; 95% CI, 0.89-1.06). No significant differences between the groups were observed in the secondary outcome measures (sudden death, mortality from any heart disease, or incidence of fatal and nonfatal myocardial infarction and stroke). CONCLUSIONS AND RELEVANCE Echocardiographic screening for structural and valvular heart disease in the general population provided no benefit for mortality or for the risk of myocardial infarction or stroke.

Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals

“…Unrestricted population screening using echocardiography is not an answer since it has a low yield 3 and is therefore more likely to cause anxiety 4,5 than find clinically significant abnormalities. However it has been suggested 6,7 that echocardiography should be more readily available for patients with a high likelihood of cardiac disease based on history, signs or symptoms.…”

Coronary artery disease screening and prognosis in incident dialysis patients

“…In a randomized controlled trial [19], ultrasound screening for AAA was found to be not effective in men aged 65-83 years and did not reduce overall death rates. Another study [20] showed that echocardiographic screening for structural and valvular heart disease in the general population provided no benefit for mortality or for the risk of myocardial infarction or stroke. The reasons for the contrary outcomes between those studies remain unclear; however, some potential underlying reasons might exist.…”

Part I - Sudden Cardiac Death in Athletes Pathophysiologic Screening: A Transformative Solution to a Social Imperative

“…Disease should not be defined or managed by measurements and ratios in isolation [23,26,27]. The pervasive use of population based associations, absence of uniform screening methodology, and the lack of a unified solution to a social imperative deserves a critical review.…”

“…Most testing modalities entrenched in consensus guidelines [68] are not capable of identifying nearterm risk(occurring within 1 year of assessment), but classify risk over many years (10 years for the Framingham Risk Score) [69,70]. Most clinical tests are currently known to be of little or no benefit in asymptomatic persons [26] and include: physical exam [42], resting and stress ECG [2,37,39,40,42,43], complete, limited and/or screening echo cardiographic exam [2,18,26,71], various imaging modalities such as MRI [37], CT calcium score [37], and serum biomarkers [72][73][74], lipid profile [75] and genomic testing [75][76][77].…”