JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B

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COMPERA 2.0 risk stratification in patients with severe aortic stenosis: implication for group 2 pulmonary hypertension

Author(s): Zongye CAI, Xinrui QI, Dao ZHOU, Hanyi DAI, Abuduwufuer YIDILISI, Ming ZHONG, Lin DENG, Yuchao GUO, Jiaqi FAN, Qifeng ZHU, Yuxin HE, Cheng LI, Xianbao LIU, Jian�an WANG
Affiliation(s): Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; more
Corresponding email(s): wangjianan111@zju.edu.cn
Key Words: COMPERA 2.0; Mortality; Aortic stenosis; Pulmonary hypertension

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Zongye CAI, Xinrui QI, Dao ZHOU, Hanyi DAI, Abuduwufuer YIDILISI, Ming ZHONG, Lin DENG, Yuchao GUO, Jiaqi FAN, Qifeng ZHU, Yuxin HE, Cheng LI, Xianbao LIU, Jian�an WANG. COMPERA 2.0 risk stratification in patients with severe aortic stenosis: implication for group 2 pulmonary hypertension[J]. Journal of Zhejiang University Science B,in press.Frontiers of Information Technology & Electronic Engineering,in press.https://doi.org/10.1631/jzus.B2400057

@article{title="COMPERA 2.0 risk stratification in patients with severe aortic stenosis: implication for group 2 pulmonary hypertension",
author="Zongye CAI, Xinrui QI, Dao ZHOU, Hanyi DAI, Abuduwufuer YIDILISI, Ming ZHONG, Lin DENG, Yuchao GUO, Jiaqi FAN, Qifeng ZHU, Yuxin HE, Cheng LI, Xianbao LIU, Jian�an WANG",
journal="Journal of Zhejiang University Science B",
year="in press",
publisher="Zhejiang University Press & Springer",
doi="https://doi.org/10.1631/jzus.B2400057"
}

%0 Journal Article
%T COMPERA 2.0 risk stratification in patients with severe aortic stenosis: implication for group 2 pulmonary hypertension
%A Zongye CAI
%A Xinrui QI
%A Dao ZHOU
%A Hanyi DAI
%A Abuduwufuer YIDILISI
%A Ming ZHONG
%A Lin DENG
%A Yuchao GUO
%A Jiaqi FAN
%A Qifeng ZHU
%A Yuxin HE
%A Cheng LI
%A Xianbao LIU
%A Jian�an WANG
%J Journal of Zhejiang University SCIENCE B
%P 1076-1085
%@ 1673-1581
%D in press
%I Zhejiang University Press & Springer
doi="https://doi.org/10.1631/jzus.B2400057"

TY - JOUR
T1 - COMPERA 2.0 risk stratification in patients with severe aortic stenosis: implication for group 2 pulmonary hypertension
A1 - Zongye CAI
A1 - Xinrui QI
A1 - Dao ZHOU
A1 - Hanyi DAI
A1 - Abuduwufuer YIDILISI
A1 - Ming ZHONG
A1 - Lin DENG
A1 - Yuchao GUO
A1 - Jiaqi FAN
A1 - Qifeng ZHU
A1 - Yuxin HE
A1 - Cheng LI
A1 - Xianbao LIU
A1 - Jian�an WANG
J0 - Journal of Zhejiang University Science B
SP - 1076
EP - 1085
%@ 1673-1581
Y1 - in press
PB - Zhejiang University Press & Springer
ER -
doi="https://doi.org/10.1631/jzus.B2400057"

Abstract
Chinese Summary
Academic Network
Reviewer Comment

Abstract: 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.

严重主动脉瓣狭窄患者的COMPERA 2.0风险分层：对左心疾病相关肺动脉高压的启示

蔡宗烨^1,2,3，戚鑫瑞^1,2,3，周道^1,2,3，戴晗怡^1,2,3，阿不都吾甫尔·依迪力斯^1,2,3，钟茗⁴，邓林⁵，郭宇超^1,2,3，范嘉祺^1,2,3，朱齐丰^1,2,3，何宇欣^1,2,3，李程^1,2,3，刘先宝^1,2,3，王建安^1,2,3
¹浙江大学医学院附属第二医院心血管内科，中国杭州市， 310009
²经血管植入器械国家重点实验室，中国杭州市， 310009
³浙江省心血管介入与再生修复研究重点实验室，中国杭州市， 310009
⁴中山大学附属第七医院肾脏科，肾脏病中心，中国深圳市， 518107
⁵中山大学附属第八医院心血管内科，中国深圳市， 518033
摘要：COMPERA 2.0风险分层已被证实可用于预测毛细血管前肺动脉高压患者的预后，但对有毛细血管后肺动脉高压或左心疾病相关肺动脉高压风险的患者来说，其适用性尚不明确。本研究纳入了327名于2015年9月至2020年11月在浙江大学医学院附属第二医院接受经导管主动脉瓣置换术（TAVR）的重度主动脉瓣狭窄（SAS）患者，探讨COMPERA 2.0危险分层是否可以判断患者的预后。根据COMPERA 2.0风险评分，在TAVR的治疗前后将患者分为四个风险等级，主要终点为全因死亡率。应用Kaplan-Meier曲线、log-rank检验和Cox比例风险模型进行生存分析。结果显示，研究队列的中位年龄为76岁（四分位距（IQR），70?80岁），TAVR前心超估测的肺动脉收缩压为33 mmHg（IQR，27?43 mmHg）。随访26个月（IQR，15?47个月）期间，总死亡率为11.9%。在TAVR前，随着风险等级的增加，累计死亡率更高（log-rank，P<0.001）；风险等级增加一级导致死亡风险增加2.53倍（95% CI 1.54?4.18，P<0.001）。该结果与年龄、性别、估算的肾小球滤过率、血红蛋白、白蛋白以及瓣膜类型无关（HR 1.76，95% CI 1.01?3.07，P=0.047）。TAVR术后30天再评估获得相似结果。综上，COMPERA 2.0可作为接受TAVR治疗SAS患者的有效风险分层工具，因为这些患者是发生毛细血管后肺动脉高压的高危人群。该研究提示COMPERA 2.0在左心疾病相关肺动脉高压患者中具有潜在应用价值，但仍需要右心导管检查进一步明确诊断和验证其价值。

关键词组：COMPERA 2.0；死亡率；重度主动脉瓣狭窄；肺动脉高压

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严重主动脉瓣狭窄患者的COMPERA 2.0风险分层：对左心疾病相关肺动脉高压的启示

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Reference