A bedside two-parameter non-invasive score to avoid systematic right heart catheterization in patients with combined pulmonary hypertension eligible for future vasodilator therapy
V Quentin, M El Blidi, E Berthelot, C Fauvel, J C Eicher, T Damy, J N Trochu, D Logeart, F Roubille, O Sitbon, P De Groote, F Picard, H Bouvaist, N Lamblin, F BauerAbstract
Background
Preliminary phase II data on sotatercept show promising hemodynamic effects in pulmonary hypertension associated with HFpEF, particularly in patients with elevated pulmonary vascular resistance (PVR) > 4 Wood units. As PVR assessment requires right heart catheterization (RHC), a non-invasive strategy with high negative predictive value to avoid systematic RHC in the most prevalent PH phenotype would be highly valuable.
Methods
In a multicenter French PH–HF cohort, we evaluated patients with pulmonary hypertension complicating HFpEF who underwent comprehensive echocardiography and right heart catheterization. Among the 20 most relevant parameters, univariable and multivariable logistic regression analyses were performed, followed by weighted score derivation and bootstrap resampling.
Results
Among 201 patients with HFpEF and PH, 62 (31%) had PVR > 4WU. Age and the TAPSE/PASP ratio emerged as the strongest non-invasive predictors of elevated PVR. A simple weighted score was derived using age ≥70 years (1 point) and TAPSE/PASP ≤0.33 (2 points), defining three risk categories: low risk (score 0–1), intermediate risk (score 2), and high risk (score 3). Patients classified as low risk (score 0–1) had a low probability of PVR > 4 (13%, 95% bootstrap CI 7–20), whereas intermediate-risk patients (score 2) had a substantially higher probability (46%, 95% CI 30–63). Patients in the high-risk group (score 3), combining advanced age and impaired right ventricular–pulmonary arterial coupling, showed the highest probability of elevated PVR (58%, 95% CI 43–71). When using a score 0-1 to indicate low risk, the score demonstrated a sensitivity of 0.76 (95% CI 0.65–0.86, figure) and a negative predictive value of 0.87 (95% CI 0.80–0.93) for the identification of patients without elevated PVR.
Conclusion
Combined all together in a score, both age < 70 yo and TAPSE/PASP > 0.33 mm/mmHg have a strong negative predictive value to avoid systematic RHC for future candidacy to vasodilation therapy.ROC curve of the non-invasive scoreFor image description, please refer to the figure legend and surrounding text.