The Diagnostic Value of Transthoracic Echocardiography for Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Abstract

Purpose

Pulmonary hypertension (PH) is an important cause of morbidity and mortality. A commonly proposed non-invasive method in the diagnosis and assessment of PH is Transthoracic Echocardiography (TTE). In this systematic review and meta-analysis, our aim was to assess the accuracy of echocardiography in the diagnosis of PH.

Methods

The search was done up to the 31st of January 2023 using MEDLINE, Scopus, CENTRAL, and Web of Sciences databases. The studies were included if they were randomized controlled trials or observational in design and evaluated the diagnostic performance of TTE in diagnosing PH in comparison to right-sided heart catheterization as a reference method. The diagnostic performance measures included sensitivity, specificity, Diagnostic Odds Ratio (DOR), Positive Likelihood Ratio (PLR), and Negative Likelihood Ratio (NLR).

Results

The total number of the included patients was 4,523 from 38 articles. The overall sensitivity and specificity of echocardiography in diagnosing pulmonary hypertension were 54.8% (95%CI: 45.7%-63.6%) and 52.1% (95%CI: 39.0%-64.9%), respectively. Moreover, the pooled DOR was 1.321 (95%CI: 0.695-2.51). The pooled PLR and NLR were 1.145 (95%CI: 0.830-1.579) and 0.867 (95%CI: 0.628-1.197), respectively. The highest diagnostic performance of TTE was among group 1 and 3 PH patients.

Conclusion

Our analysis revealed that TTE had low diagnostic sensitivity, specificity, and accuracy. Due to the overall poor diagnostic performance of TTE, the diagnosis of PH and the assessment of response to therapies require right-sided heart catheterization. Future prospective studies to improve the diagnostic performance of TTE in the diagnosis of PH are needed.