TY - JOUR
T1 - Performance of echocardiography for detection of portopulmonary hypertension among liver transplant candidates
T2 - Meta-analysis
AU - Korbitz, Parker M.
AU - Gallagher, John P.
AU - Samant, Hrishikesh
AU - Singh, Shailender
AU - Jophlin, Loretta
AU - Ingviya, Thammasin
AU - Manatsathit, Wuttiporn
N1 - Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2020/11
Y1 - 2020/11
N2 - 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.
AB - 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.
KW - cirrhosis
KW - echocardiography
KW - liver transplantation
KW - portal hypertension
KW - portopulmonary hypertension
KW - right heart catheterization
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U2 - 10.1111/ctr.13995
DO - 10.1111/ctr.13995
M3 - Article
C2 - 32485008
AN - SCOPUS:85091518980
SN - 0902-0063
VL - 34
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 11
M1 - e13995
ER -