Development of a Noninvasive Prediction Score for Post-Capillary Pulmonary Hypertension in a Multi-Ethnic Asian Population

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 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: (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.