Perspective:

This long-term longitudinal study nicely demonstrates that screening echocardiography done in a blind fashion without a clear cut indication confers no beneficial impact on overall mortality or rates of cardiovascular events or stroke. A total of 362 subjects had identifiable abnormalities on screening echocardiography, 290 of whom were actively followed by the division of cardiology at the investigating institution. The single most prevalent abnormality to be identified in the screening group was valvular heart disease, including a remarkably low prevalence of bicuspid aortic valve (<1%) and variable degrees of mitral stenosis or insufficiency. Without further information regarding severity, it is difficult to come to conclusions as to whether the valve lesions would be anticipated to result in cardiovascular mortality over the 15-year follow-up. Similarly, other entities such as ventricular hypertrophy (presumably related to hypertension) would be equivalently present in the nonechocardiographic subgroup, as would asymptomatic left ventricular dysfunction, left atrial dilation, and aortic dilation. Without information with respect to the severity of these lesions, and whether they would cross thresholds where therapeutic intervention would be likely to be beneficial, it is difficult to say whether echocardiography plausibly would have impacted outcome. In an era of concern regarding overutilization and occasionally a push for an abbreviated ultrasound exam using a hand-held device, this study nicely demonstrates that major morbidity and mortality are not impacted by such a strategy in the general (presumably asymptomatic) population, and that echocardiography (and other imaging modalities) should be reserved for targeted evaluation of individuals clinically suspected of having specific diseases for which specific therapy is intended.