Abstract/Description
Background: Acute Valve Syndrome (AVS) identifies a high-risk cohort of aortic stenosis (AS) patients with poor outcomes following aortic valve replacement (AVR), but the spectrum of risk within this group has yet to be fully explored. We sought to evaluate whether admission markers facilitated risk stratification of 1-year mortality in an AVS cohort.
Methods: In a retrospective cohort study (MIMIC-IV v3.1), we identified 2,380 adults who underwent AVR between 2008–2019. Patients were classified as AVS or progressive valvular disease (PVD). AVS was defined by criteria of acute decompensation, including advanced heart failure symptoms, cardiogenic shock, or significant hyperlactatemia. The AVS cohort was further stratified by the number of admission risk factors: renal dysfunction (creatinine ≥2.0 mg/dL), high lactate (≥4 mmol/L), liver injury (AST or ALT >60 IU/L), elevated NT-proBNP (>1500 pg/mL), and preoperative vasoactive agent use. The primary outcome was 1-year all-cause mortality.
Results: Among 2,380 AVR patients, 1,216 (51.1%) met AVS criteria. One-year mortality was higher in AVS vs PVD (12.9% vs 5.4%; HR 1.97, 95% CI 1.47–2.64; p< 0.001). Within AVS, mortality increased stepwise with risk-factor burden: 2.0% (0 factors), 6.5% (1 factor), and 25.1% (≥2 factors; p< 0.001).
Conclusion: AVS is associated with significantly increased 1-year mortality. Admission markers of multi-organ injury effectively stratify risk within this heterogeneous population, identifying a high-risk subset with poor survival. This risk factor-based approach warrants prospective validation to improve clinical decision-making.
Faculty Advisor/Mentor
Matthew Summers, MD
Faculty Advisor/Mentor Email
mrsumme1@sentara.com
Faculty Advisor/Mentor Department
Structural Heart
Included in
Acute Valve Syndrome and 1-Year All-Cause Mortality Post-AVR: A Retrospective Cohort Study
Background: Acute Valve Syndrome (AVS) identifies a high-risk cohort of aortic stenosis (AS) patients with poor outcomes following aortic valve replacement (AVR), but the spectrum of risk within this group has yet to be fully explored. We sought to evaluate whether admission markers facilitated risk stratification of 1-year mortality in an AVS cohort.
Methods: In a retrospective cohort study (MIMIC-IV v3.1), we identified 2,380 adults who underwent AVR between 2008–2019. Patients were classified as AVS or progressive valvular disease (PVD). AVS was defined by criteria of acute decompensation, including advanced heart failure symptoms, cardiogenic shock, or significant hyperlactatemia. The AVS cohort was further stratified by the number of admission risk factors: renal dysfunction (creatinine ≥2.0 mg/dL), high lactate (≥4 mmol/L), liver injury (AST or ALT >60 IU/L), elevated NT-proBNP (>1500 pg/mL), and preoperative vasoactive agent use. The primary outcome was 1-year all-cause mortality.
Results: Among 2,380 AVR patients, 1,216 (51.1%) met AVS criteria. One-year mortality was higher in AVS vs PVD (12.9% vs 5.4%; HR 1.97, 95% CI 1.47–2.64; p< 0.001). Within AVS, mortality increased stepwise with risk-factor burden: 2.0% (0 factors), 6.5% (1 factor), and 25.1% (≥2 factors; p< 0.001).
Conclusion: AVS is associated with significantly increased 1-year mortality. Admission markers of multi-organ injury effectively stratify risk within this heterogeneous population, identifying a high-risk subset with poor survival. This risk factor-based approach warrants prospective validation to improve clinical decision-making.