ORCID
0000-0001-9627-6236 (Benza)
Document Type
Article
Publication Date
2025
DOI
10.1016/j.shj.2025.100766
Publication Title
Structural Heart
Volume
Advance online publication
Pages
100766
Abstract
Background: Acute valve syndrome (AVS) represents a high-risk phenotype of advanced valvular disease with largely uncharacterized risk heterogeneity. We aimed to validate an expanded AVS definition and develop a physiology-dependent risk stratification tool using available clinical markers.
Methods: This retrospective study analyzed 2380 patients undergoing aortic valve replacement for severe aortic stenosis and classified them as AVS (n = 1556) or progressive valvular disease (n = 824). The primary outcome was 1-year all-cause mortality. An L2-regularized logistic regression model was developed to predict 1-year mortality using admission laboratory markers and comorbidity burden. Model performance was assessed using nested cross-validation with calibration metrics including the Brier score. The constituent risk factors were aggregated into an Ischemic Physiology Score.
Results: AVS patients (65.4%) showed higher comorbidity burden and higher 1-year mortality (11.6 vs. 4.7%; p < 0.001) than progressive valvular disease. The prediction model performed well (area under the receiver operating characteristic curve [AUC]: 0.765 ± 0.043, Brier Score: 0.094) during five-fold cross-validation. The Ischemic Physiology Score, incorporating renal dysfunction, hyperlactatemia, liver injury, elevated natriuretic peptides, high comorbidity burden, and preoperative vasoactive support, stratified patients into 3 risk groups with 1-year mortality of 1.9% (0 factors), 9.7% (1 factor), and 25.5% (≥2 factors) (p < 0.001 for trend). Multivariable analysis identified the Charlson Comorbidity Index, aspartate aminotransferase/alanine aminotransferase, lactate, N-Terminal pro-B type natriuretic peptide, and creatinine as independent predictors of 1-year mortality in our AVS cohort.
Conclusions: AVS is the predominant clinical phenotype within our cohort, appearing in over half of our patients undergoing aortic valve replacement. Complementing existing surgical risk scores to guide intervention optimization, a physiologic score based on admission data effectively stratifies patient risk.
Rights
© 2025 The Authors.
This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).
Data Availability
Article states: "Supplemental data for this article can be accessed on the 10.1016/jshj.2025.100766."
Original Publication Citation
Saleh, O., Valle, N. J., Saleh, I., Benza, R., Talreja, D. R., & Summers, M. R. (2025). Physiologic markers of mortality in acute valve syndrome: An ischemic physiology score stratifies patient risk. Structural Heart. Advance online publication. https://doi.org/10.1016/j.shj.2025.100766
Repository Citation
Saleh, O., Valle, N. J., Saleh, I., Benza, R., Talreja, D. R., & Summers, M. R. (2025). Physiologic markers of mortality in acute valve syndrome: An ischemic physiology score stratifies patient risk. Structural Heart. Advance online publication. https://doi.org/10.1016/j.shj.2025.100766
Supplementary Appendix A
1-s2.0-S2474870625003586-mmc2.pdf (130 kB)
Supplementary Table 1
1-s2.0-S2474870625003586-mmc3.pdf (107 kB)
Supplementary Table 2