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. 2020 Jul 1:29:100568.
doi: 10.1016/j.ijcha.2020.100568. eCollection 2020 Aug.

Comparative accuracy of non-invasive imaging versus right heart catheterization for the diagnosis of pulmonary hypertension: A systematic review and meta-analysis

Waqas Ullah  1 , Artem Minalyan  1 , Sameer Saleem  2 , Nayab Nadeem  1 , Hafez M Abdullah  3 , Abdelmohaymin Abdalla  3 , Vincent Chan  1 , Rehan Saeed  1 , Maria Khan  4 , Sara Collins  5 , Maryam Mukhtar  6 , Harshwant Grover  1 , Yasar Sattar  7 , Ankur Panchal  8 , Smitha Narayana Gowda  3 , Uneza Khwaja  9 , Bilal Lashari  1 , David L Fischman  5
Affiliations

Comparative accuracy of non-invasive imaging versus right heart catheterization for the diagnosis of pulmonary hypertension: A systematic review and meta-analysis

Waqas Ullah et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Right heart catheterization (RHC) is the gold-standard in the diagnosis of pulmonary hypertension (PH) but at the cost of procedure-related complications. We sought to determine the comparative accuracy of RHC versus non-invasive imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and transthoracic echocardiography (TTE).

Methods: Pulmonary hypertension was defined as a mean pulmonary artery pressure (mPAP) of>20 mmHg. Multiple databases were queried for relevant articles. Raw data were pooled using a bivariate model to calculate the measures of diagnostic accuracy and to estimate Hierarchical Summary Receiver Operating Characteristic (HSROC) on Stata 13.

Results: A total of 51 studies with a total patient population of 3947 were selected. The pooled sensitivity and specificity of MRI for diagnosing PH was 0.92(95% confidence interval (CI) 0.88-0.96) and 0.86 (95% CI, 0.77-0.95), respectively. The net sensitivities for CT scan and TTE were 0.79 (95% CI 0.72-0.89) and 0.85 (95% CI 0.83-0.91), respectively. The overall specificity was 0.82 (0.76-0.92) for the CT scan and 0.71 (95% CI 0.61-0.84) for TTE. The diagnostic odds ratio (DOR) for MRI was 124 (95% CI 36-433) compared to 30 (95% CI 11-78) and 24 (95% 11-38) for CT scan and TTE, respectively. Chi-squared (x2) test showed moderate heterogeneity on the test for equality of sensitivities and specificities.

Conclusions: MRI has the highest sensitivity and specificity compared to CT and TTE. MRI can potentially serve as a surrogate technique to RHC for the diagnosis of PH.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Summary and Detailed Quality assessment of the included studies.
Fig. 1
Fig. 1
Summary and Detailed Quality assessment of the included studies.
Fig. 2
Fig. 2
PRISMA flow diagram of the included studies.
Fig. 3
Fig. 3
Forest plot showing the individual and pooled sensitivity and specificity of MRI.
Fig. 4
Fig. 4
ROC demonstrating a higher sensitivity and specificity for MRI compared to RHC.
Fig. 5
Fig. 5
Forest plot showing the individual and pooled sensitivity and specificity of CT.
Fig. 6
Fig. 6
ROC demonstrating a higher sensitivity and specificity for CT compared to RHC.
Fig. 7
Fig. 7
Forest plot showing the individual and pooled sensitivity and specificity of TTE.
Fig. 8
Fig. 8
ROC demonstrating a higher sensitivity and specificity for TTE compared to RHC.
See this image and copyright information in PMC

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