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. 2020 Aug 4;9(15):e015992.
doi: 10.1161/JAHA.119.015992. Epub 2020 Jul 31.

Noninvasive Prediction of Elevated Wedge Pressure in Pulmonary Hypertension Patients Without Clear Signs of Left-Sided Heart Disease: External Validation of the OPTICS Risk Score

Samara M A Jansen  1 , Anna E Huis In 't Veld  1 , Wouter Jacobs  2 , Hans P Grotjohan  3 , Marc Waskowsky  3 , Jan van der Maten  4 , Arno van der Weerdt  4 , Romke Hoekstra  5 , Maria J Overbeek  6 , Sjoerd A Mollema  6 , Peter Hans C G Tolen  7 , Lahssan H Hassan El Bouazzaoui  7 , Joris W J Vriend  7 , J Milena M Roorda  8 , Ramon de Nooijer  8 , Ivo van der Lee  9 , Bart A J Voogel  9 , Kathinka Peels  10 , Thomas Macken  11 , Jacqueline M Aerts  11 , Anton Vonk Noordegraaf  1 , M Louis Handoko  12 , Frances S de Man  1 , Harm Jan Bogaard  1
Affiliations

Noninvasive Prediction of Elevated Wedge Pressure in Pulmonary Hypertension Patients Without Clear Signs of Left-Sided Heart Disease: External Validation of the OPTICS Risk Score

Samara M A Jansen et al. J Am Heart Assoc. .

Abstract

Background Although most newly presenting patients with pulmonary hypertension (PH) have elevated pulmonary artery wedge pressure, identification of so-called postcapillary PH can be challenging. A noninvasive tool predicting elevated pulmonary artery wedge pressure in patients with incident PH may help avoid unnecessary invasive diagnostic procedures. Methods and Results A combination of clinical data, ECG, and echocardiographic parameters was used to refine a previously developed left heart failure risk score in a retrospective cohort of pre- and postcapillary PH patients. This updated score (renamed the OPTICS risk score) was externally validated in a prospective cohort of patients from 12 Dutch nonreferral centers the OPTICS network. Using the updated OPTICS risk score, the presence of postcapillary PH could be predicted on the basis of body mass index ≥30, diabetes mellitus, atrial fibrillation, dyslipidemia, history of valvular surgery, sum of SV1 (deflection in V1 in millimeters) and RV6 (deflection in V6 in millimeters) on ECG, and left atrial dilation. The external validation cohort included 81 postcapillary PH patients and 66 precapillary PH patients. Using a predefined cutoff of >104, the OPTICS score had 100% specificity for postcapillary PH (sensitivity, 22%). In addition, we investigated whether a high probability of heart failure with preserved ejection fraction, assessed by the H2FPEF score (obesity, atrial fibrillation, age >60 yrs, ≥2 antihypertensives, E/e' >9, and pulmonary artery systolic pressure by echo >35 mmHg), similarly predicted the presence of elevated pulmonary artery wedge pressure. High probability of heart failure with preserved ejection fraction (H2FPEF score ≥6) was less specific for postcapillary PH. Conclusions In a community setting, the OPTICS risk score can predict elevated pulmonary artery wedge pressure in PH patients without clear signs of left-sided heart disease. The OPTICS risk score may be used to tailor the decision to perform invasive diagnostic testing.

Keywords: diagnosis; heart failure; prediction models; pulmonary vasculature; validation study.

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Figures

Figure 1
Figure 1. Receiver operator characteristic (ROC) curve and optimal cutoff point of the OPTICS risk scoring system for prediction of postcapillary pulmonary hypertension.
AUC indicates area under the curve.
Figure 2
Figure 2. Flowchart representing patients’ numbers and study methods of the external OPTICS cohort.
CTEPH indicates chronic thromboembolic pulmonary hypertension; IPAH, idiopathic pulmonary arterial hypertension; LVEDP, left ventricular end‐diastolic pressure; PAH, pulmonary arterial hypertension; PAH‐CHD, pulmonary arterial hypertension due to congenital heart disease; PAH‐CTD, pulmonary arterial hypertension due to connective tissue disease; PCWP, pulmonary capillary wedge pressure; PH, pulmonary hypertension; PVOD, pulmonary veno occlusive disease; and RHC, right heart catheterization.
Figure 3
Figure 3. External validation of the OPTICS risk score and H2FPEF score.
AUC indicates area under the curve.
Figure 4
Figure 4. Description of the OPTICS risk score and point allocation for each clinical parameter, with associated probability of having postcapillary PH, based on the total score as estimated from the model.
HDL‐C indicates high‐density lipoprotein cholesterol; LDL‐C, low‐density lipoprotein cholesterol; PH, pulmonary hypertension; RV6, deflection in V6 in millimeters; and SV1, deflection in V1 in millimeters.
Figure 5
Figure 5. Pyramid graphs from the validation cohort of patients with postcapillary PH and precapillary PH, divided according to the OPTICS risk score outcomes or H2FPEF score outcomes of individual patients.
The blue line represents a cutoff of ≥104 for the OPTICS risk score and ≥6 for the H2FPEF score. PH indicates pulmonary hypertension.
Figure 6
Figure 6. Probability analysis of postcapillary PH by H2FPEF score and OPTICS score, divided according to PH group.
PH indicates pulmonary hypertension.
See this image and copyright information in PMC

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