Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China.
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Respir Res. 2022 Nov 15;23(1):312. doi: 10.1186/s12931-022-02232-1.
The COMPERA 2.0 4-stratum (4-S) risk score has been demonstrated superior over the 3-stratum (3-S) one in patients with pulmonary arterial hypertension and medically managed patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to determine the prognostic value of the original 4-S and 3-S COMPERA 2.0 risk score and two new derivative versions in CTEPH patients who underwent balloon pulmonary angioplasty (BPA).
We retrospectively enrolled 175 BPA-treated patients with CTEPH. We assessed the risk stratification before and after each BPA session of CTEPH patients by the original 4-S and 3-S COMPERA 2.0 risk score (by rounding decimal to the nearest integer) and two new proposed derivative versions: the modified version (by rounding decimal to the next integer) and a hybrid version that fuses the original and modified versions. The primary endpoint was clinical worsening events. The secondary outcomes were achieving low-risk profile and mean pulmonary arterial pressure (mPAP) < 30 mmHg at follow-up. We used the Kaplan-Meier curve analysis to assess the survival differences between stratified patients. The comparative model's performance was evaluated in terms of discrimination by Harrell's C-index.
All versions of COMPERA 2.0 4-S model outperformed the 3-S one in discriminating the differences in echocardiographic and hemodynamic parameters and clinical worsening-free survival rates. The original and hybrid 4-S model could independently predict the primary and secondary endpoints, and the hybrid version seemed to perform better. The first BPA session could significantly improve risk profiles, and these changes were associated with the likelihood of experiencing clinical worsening events, achieving a low-risk profile and mPAP < 30 mmHg at follow-up. The number of BPA sessions required to achieve low risk/mPAP < 30 mmHg increased as the baseline risk score escalated.
The COMPERA 2.0 4-S model outperformed the 3-S one in BPA-treated patients with CTEPH. The 4-S model, especially its hybrid version, could be used to predict clinical outcome before the initiation of BPA and monitor treatment response.
COMPERA 2.0 4 分层（4-S）风险评分已被证明优于 3 分层（3-S）评分，适用于肺动脉高压患者和接受药物治疗的慢性血栓栓塞性肺动脉高压（CTEPH）患者。我们旨在确定原始 4-S 和 3-S COMPERA 2.0 风险评分以及两种新衍生版本在接受球囊肺血管成形术（BPA）治疗的 CTEPH 患者中的预后价值。
我们回顾性纳入了 175 例接受 BPA 治疗的 CTEPH 患者。我们通过原始的 4-S 和 3-S COMPERA 2.0 风险评分（四舍五入到最接近的整数）以及两种新提出的衍生版本（四舍五入到下一个整数）和一种融合原始和修改版本的混合版本，评估了每次 BPA 治疗前后 CTEPH 患者的风险分层。主要终点是临床恶化事件。次要结局是在随访时达到低危谱和平均肺动脉压（mPAP）<30mmHg。我们使用 Kaplan-Meier 曲线分析评估分层患者之间的生存差异。Harrell's C-index 评估了比较模型的判别能力。
所有版本的 COMPERA 2.0 4-S 模型在区分超声心动图和血流动力学参数以及临床恶化无事件生存率方面均优于 3-S 模型。原始和混合 4-S 模型可以独立预测主要和次要终点，并且混合版本似乎表现更好。第一次 BPA 治疗可显著改善风险谱，这些变化与发生临床恶化事件、达到低危谱和 mPAP<30mmHg 的可能性相关。随着基线风险评分的升高，达到低危/mPAP<30mmHg 所需的 BPA 治疗次数增加。
COMPERA 2.0 4-S 模型在接受 BPA 治疗的 CTEPH 患者中优于 3-S 模型。4-S 模型，尤其是其混合版本，可用于预测 BPA 治疗前的临床结局，并监测治疗反应。
