Background 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). Methods 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. Results 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. Conclusions 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.

Background: Adaptive statistical iterative reconstruction-V technique (ASIR-V) is usually set at different strengths according to the different clinical requirements and scenarios encountered when setting scanning protocols, such as setting a more aggressive tube current reduction (defined as preset ASIR-V).Reconstruction with ASIR-V is useful after scanning using image algorithms to improve image quality (defined as postset ASIR-V). The aim of this study was to investigate the quality of images reconstructed with preset and postset ASIR-V, using the same noncontrast abdominal-pelvic computed tomography (CT) protocols in the same individual on a wide detector CT.Methods: We prospectively enrolled 141 patients. The scan protocols in Groups A-E were 0%, 20%, 40%, 60%, and 80% preset ASIR-V, respectively, in the 256 wide-detector row Revolution CT (GE Healthcare, Waukesha, WI, USA). Each group was further divided into 5 subgroups with 0%, 20%, 40%, 60%, and 80% postset ASIR-V, respectively. The 64-detector Discovery 750 HDCT (GE, USA) was used for Group F as a control group, using 0%, 20%, 40%, 60%, and 80% ASIR, respectively. Image noise was measured in the spleen, aorta, and muscle. The CT attenuation and image noise were analyzed using the paired t-test; analysis of variance and post hoc multiple comparisons were made using the Student-Newman-Keuls (SNK) method.

Aims: Impairment of right ventricle-to-pulmonary artery coupling (RV-PA coupling) is a major determinant of poor prognosis in patients with pulmonary hypertension. This study sought to evaluate the ability of an echo-derived metric of RV-PA coupling, the ratio between tricuspid annular plane systolic excursion (TAPSE), and pulmonary artery systolic pressure (PASP) and to predict adverse clinical outcomes in chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results: A total of 205 consecutive patients with confirmed CTEPH were retrospectively recruited from Fuwai Hospital between February 2016 and November 2020. Baseline echocardiography, right heart catheterization, and cardiopulmonary exercise testing were analyzed. Patients with lower TAPSE/PASP had a significantly compromised echocardiographic and hemodynamic status and exercise capacity at baseline. The TAPSE/PASP ratio correlated significantly with hemodynamic parameters, including pulmonary vascular resistance ( r = −0.48, p < 0.001) and pulmonary arterial compliance ( r = 0.45, p < 0.001). During a median period of 1-year follow-up, 63 (30.7%) patients experienced clinical worsening. The relationship between TAPSE/PASP and clinical worsening was assessed using different multivariate Cox regression models. After adjustment for a series of previously screened independent predictors, TAPSE/PASP remained significantly associated with outcomes, and the hazard ratio (per standard deviation increase) of the final model was 0.402. Conclusion: In patients with CTEPH, baseline RV-PA coupling measured as the TAPSE/PASP ratio is associated with disease severity and adverse outcomes. A low TAPSE/PASP identifies patients with a high risk of clinical deterioration, and this novel metric could be applicable for risk stratification in CTEPH.

Background: Exercise tolerance is pivotal for risk-stratification in patients with idiopathic pulmonary artery hypertension (IPAH), yet optimal risk predictors and risk thresholds remain uncertain. This study aimed to investigate risk estimates of cardiopulmonary exercise testing (CPET) associated with 5-year mortality in patients with IPAH and explore their risk thresholds and prediction capacity.Methods: Consecutive patients with IPAH who underwent right heart catheterization and CPET were retrospectively enrolled and followed up for five years. Multivariable Cox proportional hazards models were used to determine independent prognostic factors for mortality. The risk trend and threshold for mortality were exhibited using restricted cubic splines. Survival rates were estimated by Kaplan-Meier analysis stratified by various CPET parameters.Results: Among 210 patients with IPAH (75.7% female), 37 (17.6%) died during a 34-month median follow-up. Three CPET variables were independently predictive of mortality in multivariable Cox regression analysis (all P<0.05), including oxygen uptake efficiency slope (OUES), peak oxygen pulse (VO2/HR), and peak oxygen consumption (VO2), in descending order of prediction power (𝑥2 = 37.39 > 35.96 > 35.57). The levels of OUES at 0.91, peak VO2/HR at 5.3 ml·min-1·beat-1, and peak VO2 at 12.2 ml·kg-1·min-1 were respectively identified as risk thresholds for mortality. Patients below these thresholds had significantly higher mortality risk (adjusted hazard ratio of OUES: 3.34; peak VO2/HR: 3.76; and peak VO2: 1.56) and lower survival rates (log-rank test, all P<0.01). The joint model (area under the curve [AUC] 0.838) of these CPET variables (AUC 0.724) and estimates in contemporary risk assessment tools (AUC 0.809) provided more excellent prediction capacity for 5-year mortality. Conclusions: Suboptimal exercise tolerance indicated by OUES, peak VO2/HR, and peak VO2 under certain thresholds posed a higher mortality risk in patients with IPAH, and their joint combination further improved the prediction capacity.

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