Er 2010.

Study characteristics
Patient Sampling	Prospective
Patient characteristics and setting	Study location: Germany Study periods: from December 2008 to June 2010 Care setting: the Cardiology Department of the University of Cologne Participants enrolled: 50 Participants included in analysis: 50: 14 males and 36 females Age: mean age 66.9 ± 14.5 years BMI: mean 27.1 ± 5.1 Classification of PH defined by WHO (diagnosis from right‐heart catheterisation): not reported Number of patients with asymptomatic or mild symptom: 6 (8%) Number of participants with COPD: not reported Number of intubated participants: 0 Inclusion criteria: Consecutive patients referred to the Cardiology Department of the University of Cologne were included. Exclusion criteria: Patients were excluded when tricuspid regurgitation jet was not available.
Index tests	Description of index test: using a Phillips iE33 ultrasound device equipped with a standard transducer operating at 1–5 MHz without using saline contrast. The echocardiography was performed by three different cardiologists. In each patient only one cardiologist performed the examination, randomly. Multiple views were recorded to identify optimal view for analysis as recommended in actual guidelines. Description of method to estimate right atrial pressure: The right atrial pressure was estimated by evaluating IVC diameter and change with respiration: when IVC diameter was less than 20 mm and the collapsibility greater than 50%, right atrial pressure was estimated to be 5 mmHg versus 10 mmHg when the collapsibility was less than 50%. When the IVC diameter was greater than 20 mm, right atrial pressure was estimated to be 15 mmHg when the collapsibility was greater than 50% and to be 20 mmHg when the collapsibility was less than 50%. Cut‐off value to declare PH: 38 mmHg Estimated systolic pulmonary arterial pressure: mean 62.3 ± 25.7 mmHg Sonographer qualification: performed by cardiologists How to handle the uninterpretable results: not applicable
Target condition and reference standard(s)	Target condition: pulmonary hypertension Description of reference standard: Right‐heart catheterisation was performed without sedation at rest in the cardiac catheter laboratory of the Cardiology Department of the University of Cologne. End‐expiratory pressure measurements were taken from the right atrium, right ventricle, pulmonary artery and pulmonary capillary. Mean pulmonary arterial pressure: mean 39.5 ± 14.9 mmHg
Flow and timing	The interval between the index test and reference standard: within 120 minutes Number of indeterminates for whom the results of reference standard was available: 0 (0%) Number of patients who were excluded from the analysis: 0 (0%)
Comparative
Notes
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Did the study avoid inappropriate exclusions?	Yes
Could the selection of patients have introduced bias?		Low risk
Are there concerns that the included patients and setting do not match the review question?			High
DOMAIN 2: Index Test (All tests)
Were the index test results interpreted without knowledge of the results of the reference standard?	Unclear
If a threshold was used, was it pre‐specified?	No
Could the conduct or interpretation of the index test have introduced bias?		Unclear risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 3: Reference Standard
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
Were the criteria of reference standard for target condition prespecified?	Unclear
Could the reference standard, its conduct, or its interpretation have introduced bias?		Unclear risk
Are there concerns that the target condition as defined by the reference standard does not match the question?			Low concern
DOMAIN 4: Flow and Timing
Was the interval between the index test and reference standard less than one day?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
Could the patient flow have introduced bias?		Low risk