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

Background Although most newly presenting patients with pulmonary hypertension (PH ) have elevated pulmonary artery wedge pressure, identification of so‐called postcapillaryPH can be challenging. A noninvasive tool predicting elevated pulmonary artery wedge pressure in patients with incidentPH 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 postcapillaryPH patients. This updated score (renamed theOPTICS risk score) was externally validated in a prospective cohort of patients from 12 Dutch nonreferral centers the OPTICS network. Using the updatedOPTICS risk score, the presence of postcapillaryPH could be predicted on the basis of body mass index ≥30, diabetes mellitus, atrial fibrillation, dyslipidemia, history of valvular surgery, sum ofSV 1 (deflection in V1 in millimeters) andRV 6 (deflection in V6 in millimeters) on ECG, and left atrial dilation. The external validation cohort included 81 postcapillaryPH patients and 66 precapillaryPH patients. Using a predefined cutoff of >104, theOPTICS score had 100% specificity for postcapillaryPH (sensitivity, 22%). In addition, we investigated whether a high probability of heart failure with preserved ejection fraction, assessed by the H2 FPEF 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 (H2 FPEF score ≥6) was less specific for postcapillaryPH .Conclusions In a community setting, theOPTICS risk score can predict elevated pulmonary artery wedge pressure inPH patients without clear signs of left‐sided heart disease. TheOPTICS risk score may be used to tailor the decision to perform invasive diagnostic testing.