COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension(PH).However,its suitability for patients at risk for post-capillary PH or PH associated with left...COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension(PH).However,its suitability for patients at risk for post-capillary PH or PH associated with left heart disease(PH-LHD)is unclear.To investigate the use of COMPERA 2.0 in patients with severe aortic stenosis(SAS)undergoing transcatheter aortic valve replacement(TAVR),who are at risk for post-capillary PH,a total of 327 eligible SAS patients undergoing TAVR at our institution between September 2015 and November 2020 were included in the study.Patients were classified into four strata before and after TAVR using the COMPERA 2.0 risk score.The primary endpoint was all-cause mortality.Survival analysis was performed using Kaplan-Meier curves,log-rank test,and Cox proportional hazards regression model.The study cohort had a median(interquartile range)age of 76(70–80)years and a pulmonary arterial systolic pressure of 33(27–43)mmHg(1 mmHg=0.133 kPa)before TAVR.The overall mortality was 11.9%during 26(15–47)months of follow-up.Before TAVR,cumulative mortality was higher with an increase in the risk stratum level(log-rank,both P<0.001);each increase in the risk stratum level resulted in an increased risk of death(hazard ratio(HR)2.53,95%confidential interval(CI)1.54–4.18,P<0.001),which was independent of age,sex,estimated glomerular filtration rate(eGFR),hemoglobin,albumin,and valve type(HR 1.76,95%CI 1.01–3.07,P=0.047).Similar results were observed at 30 d after TAVR.COMPERA 2.0 can serve as a useful tool for risk stratification in patients with SAS undergoing TAVR,indicating its potential application in the management of PH-LHD.Further validation is needed in patients with confirmed post-capillary PH by right heart catheterization.展开更多
基金supported by the National Key R&D Program of China(Nos.2019YFA0110400 and 2016YFC13010204)the National Natural Science Foundation of China(Nos.81870292,81570233,81770252,and 82100060)+2 种基金the China Postdoctoral Science Foundation(Nos.2020M680079 and 2021T140598)the Zhejiang Province Science and Technology Department Key R&D Program(Nos.2021C03097 and 2022C03063)the Zhejiang Provincial Natural Science Foundation of China(No.LQ21H020005).
文摘COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension(PH).However,its suitability for patients at risk for post-capillary PH or PH associated with left heart disease(PH-LHD)is unclear.To investigate the use of COMPERA 2.0 in patients with severe aortic stenosis(SAS)undergoing transcatheter aortic valve replacement(TAVR),who are at risk for post-capillary PH,a total of 327 eligible SAS patients undergoing TAVR at our institution between September 2015 and November 2020 were included in the study.Patients were classified into four strata before and after TAVR using the COMPERA 2.0 risk score.The primary endpoint was all-cause mortality.Survival analysis was performed using Kaplan-Meier curves,log-rank test,and Cox proportional hazards regression model.The study cohort had a median(interquartile range)age of 76(70–80)years and a pulmonary arterial systolic pressure of 33(27–43)mmHg(1 mmHg=0.133 kPa)before TAVR.The overall mortality was 11.9%during 26(15–47)months of follow-up.Before TAVR,cumulative mortality was higher with an increase in the risk stratum level(log-rank,both P<0.001);each increase in the risk stratum level resulted in an increased risk of death(hazard ratio(HR)2.53,95%confidential interval(CI)1.54–4.18,P<0.001),which was independent of age,sex,estimated glomerular filtration rate(eGFR),hemoglobin,albumin,and valve type(HR 1.76,95%CI 1.01–3.07,P=0.047).Similar results were observed at 30 d after TAVR.COMPERA 2.0 can serve as a useful tool for risk stratification in patients with SAS undergoing TAVR,indicating its potential application in the management of PH-LHD.Further validation is needed in patients with confirmed post-capillary PH by right heart catheterization.
