A Systematic Review of Echocardiographic Parameters for the Screening of Pulmonary Hypertension: What Are the Odds?

Pulmonary hypertension (PH) is an insidious disease that often presents in late stages due to nonspecific signs and symptoms. Right heart catheterization (RHC) is the gold standard diagnostic test, and echocardiogram (ECHO) is the best screening tool. However, the strength of evidence and diagnostic utility of various echocardiographic parameters to screen for is not well elucidated. This systematic review (SR) is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature searches was performed for the period of January 1, 2016, to June 1, 2021, on seven databases. We included full-text studies with adult patients that used RHC for comparison and provided sensitivity and specificity results. Likelihood ratios (LRs) and diagnostic odds ratios (DORs) were calculated. Risk of bias was assessed using the Quality Assessment Tool for the Observational Cohort and Cross-Sectional Studies. We identified 102 studies, but only 14 satisfied our inclusion criteria. The most significant parameters identified for PH screening based on LRs are, in descending order, tricuspid regurgitation gradient peak >36mmHg, systolic pulmonary artery pressure >41mmHg, and tricuspid regurgitation velocity >2.9 m/s. There is strong correlation between LR and DOR for these parameters. This SR indicates the superiority of some ECHO parameters over others to aid in the screening and severity assessment of PH. Variables with low LR (-) ratios may help to prevent unnecessary invasive assessment for PH. Clinicians should utilize a multi-parameter approach when interpreting echocardiograms for PH assessment.