October 8, 2010Open Access

Diagnostic Value of Transthoracic Doppler Echocardiography in Pulmonary Hypertension: A Meta-Analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Pulmonary hypertension. Intervention: Transthoracic Doppler echocardiography (TDE). Primary outcome: Diagnosis of pulmonary hypertension (DOR 11.36, 95% CI 4.62-27.94).

Key Result

Transthoracic Doppler echocardiography demonstrated acceptable sensitivity (0.82; 95% CI 0.76-0.88) but insufficient specificity (0.68; 95% CI 0.64-0.72) for diagnosing pulmonary hypertension.

Study Design

Type

Meta-Analysis

Structured PICO

Does transthoracic Doppler echocardiography accurately diagnose pulmonary hypertension?

Population

Patients with suspected pulmonary hypertension (6 studies)

Intervention

Transthoracic Doppler echocardiography (TDE)

Outcome

Diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio) for pulmonary hypertensionsurrogate

Transthoracic Doppler echocardiography has acceptable sensitivity but insufficient specificity for detecting pulmonary hypertension in isolation, making it useful primarily as a first-line surveillance modality.

Main Result

Effect estimate: DOR 11.36 (95% CI 4.62-27.94)

Abstract

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.