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COMPERA score revised: better risk estimation to better tailor therapeutics in precapillary hypertension.
Session:
Comunicações Orais (Sessão 4) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 1 - Foco no TEP e Hipertensão Pulmonar
Speaker:
Pedro Alves Da Silva
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Alves da Silva; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Catarina Simões de Oliveira; Ana Margarida Martins; Ana Beatriz Garcia; Miguel Azaredo Raposo; Ana Abrantes; Tatiana Guimarães; Nuno Lousada; Fausto j. Pinto; Rui Plácido
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Pulmonary hypertension is a complex and often multifactorial disease, associated with mortality and morbidity, despite advances in therapeutic this last decade. Risk stratification is key in order to best follow and treat such patients; Current risk assessment tools divide patients as low, intermediate or high risk. However, most pts falls into the intermediate risk category and very recent data from the COMPERA Registry Investigators suggested that a 4-strata risk definition is more useful in categorizing these pts.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To analyse the performance of a newly proposed 4-strata model in predicting outcomes in a population with precapillary hypertension.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Retrospective observational study of a population followed in a PH reference center. Clinical, laboratory, echocardiographic and cath data were collected at baseline and follow-up. Risk score derived from the COMPERA Registry was applied, in its 3 and 4-strata version to our population. Survival was calculated with Kaplan-Meier curves.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: We analysed a population of 108 pts with precapillary hypertension - divided between PAH (49.1%) and CTEPH (50.9%) – mean age 63.1±23years, 61% were females. Regarding therapeutics, 64.8% were under endotelin antagonists, 58.3% phosphodiesterase inhibitors, 12.03% prostanoids, 19.4% riociguat and 7.6% selexipag. Both groups were homogenic, with no statistical differences, except for therapeutic with riociguat (p=0.03). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">COMPERA score – using 3-strata (low, intermediate and high risk) and 4-strata (low, intermediate low, intermediate high and high risk) - were applied with data at beginning and during follow-up and then correlated with survival and a composite endpoint of death and hospitalization – table 1. Kaplan Meier survival curves were obtained and an evident separation of the four groups were identified at early follow-up, a trend that was maintained during a 7-year follow-up. It is interesting to see that such trend was obtained in a population with PAH and in a broader population including also CTEPH.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> A ROC curve was obtained and showed a good sensitivity (AUC= 0,8525) in estimating the risk of events when applied at beginning and end of follow-up – figure 2.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: In our population, a 4-strata risk assessment tool was able to better predict outcomes (mortality and admissions) in a population with precapillary pulmonary hypertension. Its implantation will help us on selecting some pts who might benefit early double therapy.</span></span></p>
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