Role of echocardiography in screening for portopulmonary hypertension in liver transplant candidates: a meta-analysis

Abstract

Objectives To demonstrate the screening value of echocardiography for portopulmonary hypertension (POPH) in liver transplant candidates. Design Systematic review and meta-analysis. Background POPH is a complication of end-stage liver disease that adversely affects the outcome of orthotopic liver transplant. There are no specific symptoms in the early stage of POPH. POPH reduce the survival rate of patients with end-stage liver disease specially if they are not diagnosed. Therefore, early detection may improve prognosis. The objective of this study is to explore the screening value of echocardiography on liver transplant candidates for screening of POPH compared to right heart catheterization (RHC). Method PubMed, EMBASE and the Cochrane Library were searched by two independent reviewers for potentially eligible studies published up to 30 June 2019 to retrieve data based on per-patient analysis. STATA, Meta-DiSc, and RevMan were applied to perform this meta-analysis. Results Our search yielded 1576 studies, of which 11 satisfied the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the summary receiver operating characteristic (SROC) curve (AUC) of echocardiography for POPH were 0.85 (95% CI [0.65–0.94]), 0.83 (95% CI [0.73–0.90]), 4.99 (95% CI [3.03–8.21]), 0.19 (95% CI [0.07–0.46]), and 0.91 (95% CI [0.88–0.93]), respectively. Deeks’ funnel plot did not indicate the existence of publication bias (P = 0.66). Conclusions Echocardiography, a noninvasive modality, provides superior screening for POPH, but the diagnosis of POPH still requires RHC. PROSPERO registration number CRD42019144589.

Diagnostic and prognostic value of echocardiography in pulmonary hypertension: an umbrella review of systematic reviews and meta-analyses

“…Nine meta-analyses published between 2010 and 2022 reported the sensitivity and specificity of echocardiography in the detection of PH, and the number of included studies varied between 6 and 29 (Table 1 ) [ 6 – 8 , 11 , 13 , 15 – 18 ]. Seven meta-analyses did not have specific constraints on the etiology of PH, whereas two meta-analyses included patients with portopulmonary hypertension (POPH) [ 15 , 16 ]. The echocardiographic methods used to identify probable PH include sPAP, right ventricular systolic pressure (RVSP), right atrial pressure (RAP), tricuspid regurgitation pressure gradient (TRPG), and right ventricular outflow tract acceleration time (RVOT AT).…”

“…The sensitivity ranged from 0.82 to 0.88, the specificity ranged from 0.63 to 0.87, and the area under the curve (AUC) ranged from 0.81 to 0.91. The AUC of sPAP for detecting POPH was the highest (0.91) [ 16 ], and the AUC of RVOT AT was also high (0.90) for detecting PH among these parameters [ 11 ]. Moreover, eight of the nine meta-analyses used quality assessment of diagnostic studies tool (QUADAS) or QUADAS-2 for quality assessment, whereas one meta-analysis did not report quality assessment tools [ 8 ].…”

Simple algorithm to narrow down the candidates to receive echocardiography in patients with chronic liver disease for suspected pulmonary hypertension

“…For the diagnosis, invasive right heart catheterization or, alternatively, echocardiography should be performed. Actually, the previously published meta‐analysis reported that in the diagnosis of PoPH, echocardiography is useful for screening but requires catheterization for diagnosis 21 . For patients with high TRPG where pulmonary hypertension is suspected on echocardiography, RHC should be considered.…”

“…Actually, the previously published meta‐analysis reported that in the diagnosis of PoPH, echocardiography is useful for screening but requires catheterization for diagnosis. 21 For patients with high TRPG where pulmonary hypertension is suspected on echocardiography, RHC should be considered. However, in real‐world clinical practice, it is not realistic to perform invasive right heart catheterization or even echocardiography in all patients with chronic liver disease, limiting the wide range of screening.…”

Portopulmonary Hypertension: An Updated Review

“… 44 The TTE has an 85% sensitivity and 83% specificity for the detection of PoPH. 49 Therefore, it should be done on all patients with chronic liver disease that present dyspnea or inexplicable hypoxemia, as well as all patients under liver transplantation evaluation. 3 , 44 When measuring the maximum tricuspid regurgitation velocity, an echocardiographic approximation of the right systolic ventricular pressure (RSVP) is common.…”