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Development of a Noninvasive Prediction Score for Post-Capillary Pulmonary Hypertension in a Multi-Ethnic Asian
Haowen Jiang1, Stephanie Loh1, Shaw Yang Chia1
1National Heart Centre Singapore, Singapore.
Background:
Noninvasive prediction of postcapillary pulmonary hypertension (PH) is a useful clinical tool. However, existing scores are not well evaluated in Asian populations.
Objectives:
This study aimed to develop a novel prediction score for postcapillary PH in an Asian cohort.
Methods:
A single-center retrospective cohort study was performed in patients who had undergone right heart catheterization from July 2018 to June 2022. Patients with an ejection fraction <50% or moderate or worse left valvular disease were excluded. Postcapillary PH was diagnosed with a mean pulmonary arterial pressure >20 mm Hg and pulmonary capillary wedge pressure (PCWP) >15 mm Hg. A novel logistic regression model (POISE [Prediction Of raISEd wedge pressures]) was developed, with validation by bootstrapping. Comparisons against the OPTICS and H2FPEF scores were performed. Sensitivity analysis was performed excluding patients with combined pre- and post-PH.
Results:
A total of 266 patients were included, of whom 110 had a raised PCWP >15 mm Hg. Body mass index >30 (adjusted OR: 2.79; 95% CI: 1.42-5.47), atrial fibrillation (adjusted OR: 2.26; 95% CI: 1.01-5.02), E/e' ratio (adjusted OR: 1.058, 95% CI: 1.01-1.10), and left atrial index >34 cm2/m2 (adjusted OR: 2.07; 95% CI: 1.13-3.78) were significant predictors of raised PCWP (C-statistic: 0.72; 95% CI: 0.65-0.78). At a chosen cutoff of ≥0.72, POISE had a specificity of 97.4% (95% CI: 95.0%-99.9%) and sensitivity of 10% (95% CI: 4.4%-15.6%). Internal validation and sensitivity analysis excluding patients with combined pre- and post-PH revealed C-statistics of 0.70 (95% CI: 0.70-0.79) and 0.75 (95% CI: 0.67-0.81), respectively, outperforming both OPTICS and H2FPEF scores.
Conclusions:
The high specificity and better performance (vis à vis existing scores) of POISE may help in identifying a subset of Asian patients with postcapillary PH, reducing the need of right heart catheterization. POISE is available as an online risk calculator.
