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.
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

Objective To investigate the value of intravascular ultrasound (IVUS) on assessing pulmonary vascular properties (PVPs) and its relationship with hemodynamics,and mortality rate in patients with pulmonary arterial hypertension associated with connective tissue disease (PAH-CTD).Methods Patients (n =51) with highly suspected PAH-CTD were prospectively enrolled in our department between July 2011 and March 2014.All patients underwent right heart catheterization (RHC) and IVUS,and were divided into 3 groups:PAH-CTD (n =25),PAH due to other reasons (n =15),and non-PAH control group (n=11).Based on IVUS,PAH patients were divided into distal (n =22) and proximal (n =18) remodeling subtypes.A total of 408 pulmonary segments were detected by IVUS,and all patients were followed up to (19 ± 10) months.Results IVUS evidenced higher mean wall thickness (MWT) ((0.30 ± 0.02) mm and (0.33 ± 0.02) mm vs.(0.21 ± 0.02) rmm) and percentage of MWT (WTP) ((13.62 ± 0.59)％ and (14.39 0.77)％ vs.(9.57 ±0.97)％) values in PAH patients compared to control patients (all P ＜ 0.01).Pulmonary vascular mechanical properties (PVMPs) including compliance ((8.85 ± 0.82) × 10 2-mm2/mmHg(1 mmHg =0.133 kPa) and (6.28 ± 0.65) × 10--2 mm2/mmHg vs.(41.59 ± 5.02) × 10-2 mm2-/mmHg,all P ＜ 0.01),distensibility ((0.83 ± 0.09)％/mmHg and (0.55 ±0.06)％/mmHg vs.(3.16 ±0.38) ％/mmHg,all P ＜0.01),elastic modulus ((169.25 ± 15.10) mmHg and (253.00 ± 22.11) mmHg vs.(43.78 ± 4.27) mmHg,all P ＜ 0.01) and stiffness index 3 (4.19 ±0.41 and 5.18 ±0.34 vs.2.39 ±0.27,P ＜0.05 or 0.01) in PAH groups were all significantly worse than in control group (all P ＜0.01).An inverse exponential association was found between PVMPs and hemodynamics with R2 ranging from 0.544 to 0.777 (P ＜0.001).PVMPs tended to be better in group PAH-CTD than in PAH group due to other reasons.Mortality rate was similar between the two PAH groups,while PAH with distal remodeling subtype was linked with significantly higher mortality rate than PAH with the proximal remodeling subtype (23 ％ vs.0,HR =10.14,P ＜ 0.05).Conclusions IVUS plays an important role in the assessment of PAH-CTD patients in terms of evaluating PVPs and predicting mortality rate.PAH patients have deteriorated PVPs,but PVMPs tended to be better in PAH-CTD than in PAH patients due to other reasons.The mortality rate was similar between PAH groups,while PAH patients with the distal remodeling subtype is linked with a higher mortality rate than PAH patients with the proximal remodeling subtype.