Table BSummary of strength of evidence and effect estimates for echocardiography versus echocardiography plus biomarkers as screening modalities for PAH (KQ 1)a

TestSensitivitySpecificityCorrelation With RHC
Echo sPAP with NT-proBNP vs. Echo sPAP in symptomatic patientsSOE = Insufficient
(1 study, 121 patients)

NT-proBNP >80 pg/mL has a low false negative rate compared with RHC reference standard; the serial testing study design did not allow for NT-proBNP testing to improve sensitivity beyond that of echo sPAP alone.
SOE = Low
(1 study, 121 patients)

NT-proBNP ≤80 pg/mL ruled out PAH in 9–16% of patients with elevated echo sPAP ≥36 mmHg.
SOE = Insufficient
(No studies)
Echo sPAP with NT-proBNP vs. Echo sPAP in asymptomatic patientsSOE = Insufficient
(No studies)
SOE = Insufficient
(No studies)
SOE = Insufficient
(No studies)
NT-proBNP compared with RHCSOE = Low
(3 studies, 198 patients)

NT-proBNP has variable sensitivity (range, 56% to 100%) for diagnosing PAH; uncertain performance for ruling out PAH.
SOE = Low
(3 studies, 198 patients)

NT-proBNP has variable specificity (range, 24% to 95%); uncertain performance for ruling in PAH.
SOE = Moderate
(3 studies, 176 patients)

Correlation of NT-proBNP and RHC is only moderate (range, 0.43 to 0.72).
TRV/TG/sPAP compared with RHCSOE = Moderate
(19 studies, 2,459 patients)

Echocardiographic estimate of sPAP showed variable sensitivity ranging from 58% to 100%, with lower prevalence studies finding higher sensitivity.
SOE = Moderate
(19 studies, 2,459 patients)

Echocardiographic estimate of sPAP showed variable specificity ranging from 50% to 98%, with lower prevalence studies finding higher specificity.
SOE = Moderate
(23 studies, 4,217 patients)

Echocardiographic estimates of sPAP showed moderate to strong correlation (range, 0.38 to 0.96) with RHC and were on average unbiased, but were limited by imprecision and by a significant minority of patients in whom TRV was not measurable.
TRV/VTIRVOT compared with RHCSOE = Moderate
(6 studies, 196 patients)

Echocardiographic estimate of PVR showed reasonably high sensitivity (range, 89% to 100%) for ruling in PAH.
SOE = Moderate
(6 studies, 196 patients)

Echocardiographic estimate of PVR showed variable specificity (range, 50% to 97%), with better specificity in lower prevalence studies (range, 94% to 97%).
SOE = High
(6 studies, 196 patients)

Showed strong correlation between echocardiographic estimates of PVR and PVR by RHC (range, 0.74 to 0.84).

NT-proBNP = N-terminal pro-B-type natriuretic peptide; PVR = pulmonary vascular resistance; RHC = right heart catheterization; SOE = strength of evidence; sPAP = systolic pulmonary artery pressure; TRV = tricuspid regurgitant jet velocity; VTIRVOT = velocity-time integral of right ventricular outflow tract

a

Shaded background indicates insufficient strength of evidence.

Shaded background indicates insufficient strength of evidence.

From: Executive Summary

Cover of Pulmonary Arterial Hypertension: Screening, Management, and Treatment
Pulmonary Arterial Hypertension: Screening, Management, and Treatment [Internet].
Comparative Effectiveness Reviews, No. 117.
McCrory DC, Coeytaux RR, Schmit KM, et al.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.