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

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

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

Author: Zongye CAI ¹ ; Xinrui QI ¹ ; Dao ZHOU ¹ ; Hanyi DAI ¹ ; Abuduwufuer YIDILISI ¹ ; Ming ZHONG ² ; Lin DENG ³ ; Yuchao GUO ¹ ; Jiaqi FAN ¹ ; Qifeng ZHU ¹ ; Yuxin HE ¹ ; Cheng LI ¹ ; Xianbao LIU ¹ ; Jian'an WANG ⁴
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1. Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
2. Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China.
3. Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China.
4. Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China. wangjianan111@zju.edu.cn.
Publication Type:Journal Article
Keywords: Aortic stenosis; COMPERA 2.0; Mortality; Pulmonary hypertension
MeSH: Humans; Aortic Valve Stenosis/complications*; Aged; Hypertension, Pulmonary/mortality*; Male; Female; Transcatheter Aortic Valve Replacement; Aged, 80 and over; Risk Assessment/methods*; Proportional Hazards Models; Kaplan-Meier Estimate; Retrospective Studies
From: Journal of Zhejiang University. Science. B 2025;26(11):1076-1085
CountryChina
Language:English
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.