The review addressed a clear question. Inclusion criteria were defined. It would have been helpful if the authors had provided information on how many, if any, studies were excluded where they could not obtain individual patient data. Details on the search were limited with no details on search terms or dates and so the possibility of missing studies could not be ruled out. Details on the review process were not reported and so it was not possible to determine whether appropriate steps were taken to minimise bias and errors. Study quality was not formally assessed and so the risk of bias in the included studies was unclear. The robustness of the evidence was unclear as the authors did not report whether they checked the individual patient data.
It appeared that a sophisticated analysis based on individual patient data was carried out, but lack of details on exact methods used made it difficult to determine the robustness of the analysis. The authors' conclusions appeared somewhat strong and did not appear to be directly supported by the data. Although the negative predictive values for the age-derived thresholds were high, these did not differ greatly from those obtained using the thresholds recommended in existing guidelines.
The authors' conclusions regarding their age-derived thresholds do not appear to be reliable, although their recommendation that this test can be used to exclude reduced left ventricular dysfunction appears reliable.