Doppler trans‐thoracic echocardiography for detection of pul | Figure 1
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Doppler trans‐thoracic echocardiography for detection of pulmonary hypertension in adults
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What was the aim of this review?
To evaluate evidence on the ability of echocardiography to identify pulmonary hypertension in adults compared to right‐heart catheterisation.
What were the main results of the review?
We found 17 studies involving 3656 people who had suspected pulmonary hypertension.
There was a lot of variation in the studies. We found the characteristics of participants varied in terms of age, sex, cause of pulmonary hypertension, setting and country. The cut‐off values for the echocardiography readings chosen to diagnose pulmonary hypertension also varied. We used the available data to estimate how well the echocardiography performed compared to right‐heart catheterisation. In tertiary care hospitals, where most of the included studies were conducted, it is assumed that 680 of 1000 patients have pulmonary hypertension. We found that 592 people of 1000 would be correctly diagnosed with pulmonary hypertension using echocardiography. But 45 of 1000 patients would be wrongly considered as having pulmonary hypertension (false positive), while 88 of 1000 patients might be incorrectly considered as not having pulmonary hypertension (false negative) and 275 of 1000 patients would avoid unnecessary referral for a right‐heart catheterisation. In a scenario where the preoperative examination for liver transplantation is conducted, 100 of 1000 are assumed to have pulmonary hypertension. We found the number of false negatives and false positives would be 13 and 126, respectively.
How reliable were the results of the studies?
We judged the included studies to have important limitations in their validity, which means that they were at high risk of providing distorted results. Therefore, we cannot be certain if the number of false negatives is correct (i.e. it could be even higher).
Who do the results of this review apply to?
These results apply to adults who are suspected of having pulmonary hypertension. However, the diagnostic accuracy of echocardiography varied considerably among studies and it is yet unclear what causes this diversity of test accuracy. Of note, the results are from studies conducted in relatively high prevalence settings. Therefore, care should be taken when applying this result to individual situations.
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