Validation of the OPTICS and H2FPEF risk scores for post-capillary pulmonary hypertension in an asian cohort

Abstract

Abstract Background The differentiation between pre- and post-capillary pulmonary hypertension (PH) plays a significant impact in the management of PH patients. Right heart catheterization (RHC) serves as an important test to facilitate this differentiation. However, the RHC is invasive and oftentimes in Asia, the uptake and availability of the RHC due to costs and other considerations may be limited. The OPTICS score was previously developed to predict a raised pulmonary capillary wedge pressure (PCWP) in patients with PH. The H2FPEF score is typically used to predict heart failure with preserved ejection fraction (HFpEF) but has been suggested to be able to predict raised PCWP as well. Both scores have been validated in European cohorts, however the utility of this score in an Asian population is unknown. Purpose We aim to validate the utility of the OPTICS and H2FPEF scores in predicting the presence of a raised PCWP in an Asian population. Methods Available data from patients admitted to a tertiary cardiac center in Asia who had received a RHC between July 2018 to June 2022 were included. The established cut offs for the OPTICS and H2FPEF scores of ≥104 and ≥6 respectively were applied retrospectively to predict the presence of raised PCWP (defined as ≥15 mmHg) and the results compared to the actual PCWP from RHC. The receiver operating characteristic (ROC) curves and area under curves (AUC) were calculated. A sensitivity analysis was performed with the exclusion of patients with mixed PH (PCWP ≥15 mmHg with pulmonary vascular resistance ≥3 WU). Results 433 patients were included, of which 274 had a raised PCWP ≥15 mmHg and 159 had a PCWP <15 mmHg. With a cut-off of ≥104, the OPTICS risk score had a specificity of 96%, sensitivity of 20%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 41%, and accuracy of 48%. With a cut-off of ≥6, the H2FPEF score had a specificity of 86%, sensitivity of 30%, PPV of 79%, NPV of 42%, and accuracy of 51%. The OPTICS and H2FPEF scores had an AUC of 0.69 and 0.66 respectively (Figure 1). Sensitivity analysis excluding patients with mixed PH (n=173) was performed and similar results were obtained. Conclusion In our Asian cohort, the high specificity of the OPTICS score may help in better identifying a subset of PH patients with postcapillary PH, potentially reducing the need of RHC in this group and guiding overall management. The lower sensitivity of both scores suggest that these scores should not be used as routine screening tools.ROC curves of OPTICS vs H2FPEF scores