Diagnostic value of transthoracic Doppler echocardiography in pulmonary hypertension: a meta-analysis.

BACKGROUND A commonly used noninvasive method, transthoracic Doppler echocardiography (TDE) has been widely recommended for the diagnosis of pulmonary hypertension (PH). We aimed to review comprehensively the evidence for the use of TDE to diagnose PH. METHODS After a systematic review of English-language studies, we used random-effects models to pool sensitivity, specificity, and other measures of accuracy of TDE for the diagnosis of PH. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. RESULTS Six studies met our inclusion criteria. The summary estimates for TDE in the diagnosis of PH in the included studies were as follows: sensitivity, 0.82 (95% confidence interval (CI), 0.76-0.88); specificity, 0.68 (95% CI, 0.64-0.72); positive likelihood ratio (PLR), 2.88 (95% CI, 1.77-4.70); negative likelihood ratio (NLR), 0.31 (95% CI, 0.18-0.53); and diagnostic odds ratio (DOR), 11.36 (95% CI, 4.62-27.94). CONCLUSIONS Current evidence suggests that TDE is a test with acceptable mixed sensitivity, but in isolation, it has insufficient specificity for detecting PH. It may be useful as a first-line surveillance modality in patients in whom PH is suspected. The value of the combination of TDE with other noninvasive methods for PH detection warrants further investigation.