Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Dec 22;9(12):e033084.
doi: 10.1136/bmjopen-2019-033084.

Diagnostic accuracy of transthoracic echocardiography for pulmonary hypertension: a systematic review and meta-analysis

Jin-Rong Ni  1   2   3   4 , Pei-Jing Yan  5   6   7 , Shi-Dong Liu  1   2 , Yuan Hu  2 , Ke-Hu Yang  5   6   7   8 , Bing Song  9 , Jun-Qiang Lei  10   3   4   11
Affiliations
Meta-Analysis

Diagnostic accuracy of transthoracic echocardiography for pulmonary hypertension: a systematic review and meta-analysis

Jin-Rong Ni et al. BMJ Open. .

Abstract

Objective: To evaluate the diagnostic accuracy of transthoracic echocardiography (TTE) in patients with pulmonary hypertension (PH).

Design: Systematic review and meta-analysis.

Data sources and eligibility criteria: Embase, Cochrane Library for clinical trials, PubMed and Web of Science were used to search studies from inception to 19 June, 2019. Studies using both TTE and right heart catheterisation (RHC) to diagnose PH were included.

Main results: A total of 27 studies involving 4386 subjects were considered as eligible for analysis. TTE had a pooled sensitivity of 85%, a pooled specificity of 74%, a pooled positive likelihood ratio of 3.2, a pooled negative likelihood ratio of 0.20, a pooled diagnostic OR of 16 and finally an area under the summary receiver operating characteristic curve of 0.88. The subgroup with the shortest time interval between TTE and RHC had the best diagnostic effect, with sensitivity, specificity and area under the curve (AUC) of 88%, 90% and 0.94, respectively. TTE had lower sensitivity (81%), specificity (61%) and AUC (0.73) in the subgroup of patients with definite lung diseases. Subgroup analysis also showed that different thresholds of TTE resulted in a different diagnostic performance in the diagnosis of PH.

Conclusion: TTE has a clinical value in diagnosing PH, although it cannot yet replace RHC considered as the gold standard. The accuracy of TTE may be improved by shortening the time interval between TTE and RHC and by developing an appropriate threshold. TTE may not be suitable to assess pulmonary arterial pressure in patients with pulmonary diseases.

Prospero registration number: PROSPERO CRD42019123289.

Keywords: diagnostic radiology; echocardiography; hypertension.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart for identification of the studies. ﹡Habash’s study was divided into two independent parts because of the differences between the case group (Habash-1) and the control group (Habash-2). A total of 27 studies were included, but 28 sets of data were analysed.
Figure 2
Figure 2
Risk of bias and applicability concerns summary: review authors' judgements regarding each domain for each included study (n=28).
Figure 3
Figure 3
Summary receiver operating characteristic graph with 95% confidence region and 95% prediction region for transthoracicechocardiography in the diagnosis of pulmonary hypertension (n=28).
Figure 4
Figure 4
Forest plot of the sensitivity and specificity of each individual study, summary sensitivity and specificity and I2 statistic for heterogeneity (n=28).
See this image and copyright information in PMC

References

    1. Hoeper MM, Humbert M, Souza R, et al. . A global view of pulmonary hypertension. Lancet Respir Med 2016;4:306–22. 10.1016/S2213-2600(15)00543-3 - DOI - PubMed
    1. Galiè N, Rubin L, Hoeper M, et al. . Treatment of patients with mildly symptomatic pulmonary arterial hypertension with bosentan (early study): a double-blind, randomised controlled trial. Lancet 2008;371:2093–100. 10.1016/S0140-6736(08)60919-8 - DOI - PubMed
    1. Galiè N, Humbert M, Vachiery J-L, et al. . [2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension]. Kardiol Pol 2015;73:1127–206. 10.5603/KP.2015.0242 - DOI - PubMed
    1. Hoeper MM, Lee SH, Voswinckel R, et al. . Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol 2006;48:2546–52. 10.1016/j.jacc.2006.07.061 - DOI - PubMed
    1. Tian J, Zhang J, Ge L, et al. . The methodological and reporting quality of systematic reviews from China and the USA are similar. J Clin Epidemiol 2017;85:50–8. 10.1016/j.jclinepi.2016.12.004 - DOI - PubMed

Publication types