Scottish Pulmonary Vascular Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Open Heart. 2022 Apr;9(1). doi: 10.1136/openhrt-2022-002023.
Group II pulmonary hypertension (PH) can be challenging to distinguish from Group I PH without proceeding to right heart catheterisation (RHC). The diagnostic accuracy of the H2FPEF and OPTICS scores was investigated in Scotland.
Patients were included in the study if they were referred to the Scottish Pulmonary Vascular Unit between 2016 and 2020 and subsequently diagnosed with Group II PH or Group I PH which was either idiopathic, heritable or pulmonary veno-occlusive disease. The established cut offs for the H2FPEF and for the OPTICS scores were applied retrospectively to predict the presence of Group II PH. The diagnosis from the scores were compared with the MDT consensus diagnosis following RHC.
107 patients with Group I PH and 86 patients with Group II PH were included. Retrospective application of the OPTICS score demonstrated that pretest scoring would detect 28% of cases with Group II PH yet at the cost of misdiagnosing 4% of patients with Group I as Group II PH (specificity 0.96). The H2FPEF score had a far greater sensitivity (0.70) yet reduced specificity (0.91), leading to misdiagnosis of 9% of Group I PH cases.
While the specificity of these scores was high, the lack of perfect specificity limits their utility as it results in missed patients with Group I PH. As a consequence, they cannot replace RHC as the means of diagnosing the aetiology of PH in their current form. The scores may still be used to support clinical judgement or to indicate the advisability for further provocative testing at RHC.
在不进行右心导管检查（RHC）的情况下，将 II 型肺动脉高压（PH）与 I 型 PH 区分开来可能具有挑战性。在苏格兰研究了 H2FPEF 和 OPTICS 评分的诊断准确性。
如果患者在 2016 年至 2020 年期间被转介到苏格兰肺血管单位，并随后被诊断为 II 型 PH 或 I 型 PH，包括特发性、遗传性或肺静脉闭塞性疾病，则将其纳入研究。H2FPEF 和 OPTICS 评分的既定截止值被回顾性应用于预测 II 型 PH 的存在。根据 RHC 后 MDT 共识诊断对评分的诊断进行比较。
纳入 107 例 I 型 PH 患者和 86 例 II 型 PH 患者。回顾性应用 OPTICS 评分表明，术前评分可检测出 28%的 II 型 PH 病例，但代价是误诊 4%的 I 型 PH 患者为 II 型 PH（特异性 0.96）。H2FPEF 评分具有更高的敏感性（0.70），但特异性降低（0.91），导致 9%的 I 型 PH 病例误诊。
尽管这些评分的特异性很高，但特异性不足限制了它们的实用性，因为这会导致漏诊 I 型 PH 患者。因此，它们不能替代 RHC 作为诊断 PH 病因的手段。这些评分仍可用于支持临床判断或表明在 RHC 进行进一步激发试验的合理性。
