Clearing Our Vision for Discerning Precapillary From Postcapillary Pulmonary Hypertension With the OPTICS Risk Score

One of the key components of the evaluation of pulmonary hypertension (PH) is distinguishing precapillary PH from postcapillary PH. Treatments are predicated on this distinction and when misapplied can harm patients instead of the intended benefit. Drawing the line between precapillary and postcapillary PH is a challenging task: many patients present with multiple comorbidities,1–3 and a normal pulmonary artery wedge pressure (PAWP) at rest may not completely exclude group II PH as a result of heart failure with preserved ejection fraction (HFpEF).4–6 Thus, the concept of developing a pretest probability of high PAWP in patients referred for PH is quite important to assist clinicians in their decision-making process. As a single variable will unlikely be sufficient for an accurate differential diagnosis, composite scores integrating clinical and nonclinical features is the way forward.6 This is why, 5 years ago, Jacob and colleagues developed a noninvasive score to identify left-sided heart failure in a population suspected of pulmonary arterial hypertension.7