image | Taryn
Pre-test probability determines post-test probability. As such, no matter how good a test is, you can’t just apply it to everyone regardless of symptomatology and expect it to prevent illness. Then again, that is what we use good screening tests for, but usually still tailored to the right population. So, can you use echo as a screening test in the general population?
This study of nearly 7000 people in Norway (based on the Tromso Study), randomly allocated people to either echo or control. During 15 years of follow up, there was no significant difference when it came to death, risk of myocardial infarction or stroke. This fits with the guidelines. In the article , they found the prevalence of structural or valvular disease to be around 7.6%. Interestingly, in one subgroup there was a mortality benefit – those with a family history of cardiovascular disease – but post hoc subgroup analyses are always hard to hang your hat on.
It’s an interesting study, as echo is becoming increasingly popular and performed in situations where it isn’t always truly indicated. Some even say our stethoscopes will be replaced by portable ultrasound.
Check it out at JAMA Internal Medicine, here.
P.S. bonus points for picking the diagnosis in the image above.