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Diagnostic accuracy of transthoracic echocardiography for pulmonary hypertension: a systematic review and meta-analysis
  1. Jin-Rong Ni1,2,3,4,
  2. Pei-Jing Yan5,6,7,
  3. Shi-Dong Liu1,2,
  4. Yuan Hu2,
  5. Ke-Hu Yang5,6,7,8,
  6. Bing Song2,
  7. Jun-Qiang Lei1,3,4,9
  1. 1The First Hospital (the First Clinical Medical School) of Lanzhou University, Lanzhou, China
  2. 2Department of Cardiovascular Surgery, the First Hospital of Lanzhou University, Lanzhou, China
  3. 3Intelligent Imaging Medical Engineering Research Center of Gansu province, Lanzhou, China
  4. 4Precision Image and Collaborative Innovation International Scientific and Technological Cooperation Base of Gansu province, Lanzhou, China
  5. 5Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China
  6. 6Evidence-Based Social Science Research Center, Lanzhou University, Lanzhou, China
  7. 7Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
  8. 8Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
  9. 9Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
  1. Correspondence to Dr Jun-Qiang Lei; leijunqiangldyy{at}; Bing Song; songbingldyyxwk{at}


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.

  • hypertension
  • echocardiography
  • diagnostic radiology

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  • J-RN and P-JY are joint first authors.

  • Contributors The joint corresponding authors (J-QL and BS) are responsible for the design and implementation of the study. S-DL is responsible for the quality control of study selection. YH performed the quality control on the links of data extraction. K-HY provided guidance in literature retrieval and data processing methodology and was responsible for the quality evaluation part. J-RN and P-JY performed the systematic review of the literature and extracted the data. J-RN conducted the meta-analyses, and two authors (J-RN, P-JY) substantially contributed to the interpretation of the data and wrote the article. All authors repeatedly revised the article. The corresponding authors (J-QL and BS) and J-RN take responsibility for the integrity of the analyses.

  • Funding This study was supported by the Key Laboratory of Evidence Based Medicine and Knowledge Translation Foundation of Gansu Province (Grant No. GSXZYZH2018006).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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