title: Echocardiographic findings associated with mortality ortransplant in patients with pulmonary arterial hypertension:A systematic review and meta-analysis.
abstract: BACKGROUND
  Identification of patients at risk of deterioration is essential to guide clinical management in pulmonary arterial hypertension (PAH). This study aims to provide a comprehensive overview of well-investigated echocardiographic findings that are associated with clinical deterioration in PAH.
  
  
  METHODS
  MEDLINE and EMBASE databases were systematically searched for longitudinal studies published by April 2015 that reported associations between echocardiographic findings and mortality, transplant or clinical worsening. Meta-analysis using random effect models was performed for echocardiographic findings investigated by four or more studies. In case of statistical heterogeneity a sensitivity analysis was conducted.
  
  
  RESULTS
  Thirty-seven papers investigating 51 echocardiographic findings were included. Meta-analysis of univariable hazard ratios (HRs) and sensitivity analysis showed that presence of pericardial effusion (pooled HR 1.70; 95 % CI 1.44-1.99), right atrial area (pooled HR 1.71; 95 % CI 1.38-2.13) and tricuspid annular plane systolic excursion (TAPSE; pooled HR 1.72; 95 % CI 1.34-2.20) were the most well-investigated and robust predictors of mortality or transplant.
  
  
  CONCLUSIONS
  This meta-analysis substantiates the clinical yield of specific echocardiographic findings in the prognostication of PAH patients in day-to-day practice. In particular, pericardial effusion, right atrial area and TAPSE are of prognostic value.
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.|Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: V J M
authors.initials: VJM
authors.lastname: Baggen
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: M M P
authors.initials: MMP
authors.lastname: Driessen
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Post
authors.affiliation: Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: van den Bosch
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: J J M
authors.initials: JJM
authors.lastname: Takkenberg
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. G.T.Sieswerda@umcutrecht.nl.
authors.forename: G T
authors.initials: GT
authors.lastname: Sieswerda
keywords: Echocardiography; Mortality; Non-invasive imaging; Prognosis; Pulmonary arterial hypertension