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Journal of Zhejiang University SCIENCE B
ISSN 1673-1581(Print), 1862-1783(Online), Monthly
2025 Vol.26 No.11 P.1076-1085
COMPERA 2.0 risk stratification in patients with severe aortic stenosis: implication for group 2 pulmonary hypertension
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.
Key words: COMPERA 2.0; Mortality; Aortic stenosis; Pulmonary hypertension
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。
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DOI:
10.1631/jzus.B2400057
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On-line Access:
2025-11-19
Received:
2024-01-30
Revision Accepted:
2024-07-08
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2025-11-19