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Performance of echocardiography for detection of portopulmonary hypertension among liver transplant candidates: Meta‐analysis
Author(s) -
Korbitz Parker M.,
Gallagher John P.,
Samant Hrishikesh,
Singh Shailender,
Jophlin Loretta,
Ingviya Thammasin,
Manatsathit Wuttiporn
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13995
Subject(s) - portopulmonary hypertension , medicine , contraindication , liver transplantation , cardiology , receiver operating characteristic , portal hypertension , pulmonary hypertension , cutoff , cirrhosis , transplantation , pathology , alternative medicine , physics , quantum mechanics
Background Evaluation of pulmonary arterial pressure is crucial among cirrhotic patients, considering that moderate portopulmonary hypertension (POPH) is a contraindication for liver transplantation. Although right heart catheterization (RHC) is the most accurate method to diagnose POPH, it is invasive. Objective The aim of the study is to evaluate the performance of echocardiography in detecting POPH in liver transplant candidates. Methods A Literature search was performed, and pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and area under the summary receiver operating curve (AUC) were calculated. Subgroup analyses were performed based on different cutoff values for echocardiography and diagnostic criteria of RHC. Results Sensitivity, specificity, positive LR, negative LR, and AUC of echocardiography for detection of POPH were 0.86 (0.74, 0.94), 0.87 (0.84, 0.90), 7.17 (3.59, 14.31), 0.22 (0.13, 0.38), and 0.807 while they were 0.82 (0.74, 0.89), 0.81 (0.78, 0.84), 117.75 (16.03, 865.08), 0.28 (0.16, 0.50), and 0.876for detection of moderate POPH, respectively. Performance of echocardiography was not significantly different in the subgroup analyses of stringency of POPH criteria and pulmonary arterial systolic pressure (ePASP) cutoffs. Conclusions Our meta‐analysis supports utilization of echocardiography for screening of POPH. However, RHC remains essential in highly suspicious cases. Echocardiographic data other than ePASP should be evaluated in future studies.