The Diagnostic Accuracy of Doppler Echocardiography in Assessment of Pulmonary Artery Systolic Pressure: A Meta-Analysis

Background: Transthoracic echocardiography is commonly used to estimate pulmonary arterial systolic pressure (PASP) and to diagnose pulmonary hypertension (PH). However, some recent studies have questioned the accuracy of Doppler echocardiography (DE) in the assessment of PASP. The present meta-analysis was performed to estimate the accuracy, sensitivity, and specificity of DE in the assessment of PASP. Methods: A literature search and data extraction of English and non-English articles reported from May 1984 to January 2009 was performed independently by 2 investigators using MEDLINE and EMBASE databases. Articles were included if they compared DE with right heart catheterization (RHC) in the assessment of PASP. Nine articles met our criteria and were included in our meta-analysis. We conducted a meta-analysis of the results of these articles using fixed- and random-effect models to estimate the accuracy, sensitivity, and specificity of DE in the assessment of PASP. Results: The correlation between PASP estimated by DE and RHC ranged from (r=0.65, P<0.001) to (r=0.97, P<0.001). The pooled sensitivity, specificity, and accuracy of DE for the diagnosis of PH were 88% (95% confidence interval [CI], 8492%), 56% (95% CI, 4666%), and 63% (95% CI, 5373%), respectively. Conclusion: DE is a useful noninvasive modality to screen for PH and can reliably determine whether PASP is normal, mildly elevated, or markedly elevated. However, abnormal results from DE need to be confirmed by RHC.