Pulmonary Hypertension in Left Heart Disease (PH-LHD) Differentiation Index

Pulmonary Hypertension in Left Heart Disease (PH-LHD) Differentiation Index: Explanation and Clinical Context This calculator integrates non-invasive evidence to help differentiate pulmonary arterial hypertension (PAH) from PH due to left heart disease (PH-LHD). The H2FPEF score (Reddy et al., 2018) estimates HFpEF probability using atrial fibrillation (3), BMI >30 (2), ≥2 antihypertensives (1), age >60 (1), E/e' >9 (1), and PASP >35 (1). Scores ≥6 indicate a high likelihood of HFpEF, which strengthens suspicion for PH-LHD.

The pragmatic PH-LHD signal counts bedside findings associated with postcapillary PH: obesity, diabetes, AF, dyslipidemia, LA dilation, ECG LVH, and prior valvular surgery. It provides clinical gestalt support, not a diagnostic replacement for invasive hemodynamics. If available, the OPTICS score (≥104) adds strong specificity for postcapillary PH, validated in multiple cohorts.