Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE Score
Background A user‐friendly tool that integrates key clinical variables to estimate prognosis in aortic regurgitation is lacking. We aimed to develop and validate a nomogram‐based score to predict survival and identify high‐risk patients for timely aortic valve surgery referral. Methods and Results F...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039169 |
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| Summary: | Background A user‐friendly tool that integrates key clinical variables to estimate prognosis in aortic regurgitation is lacking. We aimed to develop and validate a nomogram‐based score to predict survival and identify high‐risk patients for timely aortic valve surgery referral. Methods and Results From 2008 to 2022, 1229 patients (derivation data set: 764 Taiwanese; validation data set: 465 Japanese; age: 64±17 years) with isolated chronic moderately severe to severe aortic regurgitation from 3 centers were included. All echocardiograms were reviewed de novo. At a median follow‐up of 5.0 (interquartile range, 2.2–8.2) years, 204 all‐cause deaths occurred and 247 underwent aortic valve surgery within 3 months. In multivariable analysis, age (P<0.001), Charlson Comorbidity Index (P<0.001), New York Heart Association functional class IV (P<0.001), left ventricular ejection fraction (P<0.001), left ventricular end‐systolic dimension index (P=0.03), and aortic valve surgery in 3 months (P=0.03) were associated with all‐cause death. These variables, along with sex and maximal aorta diameter index, were incorporated into the combined left ventricular ejection fraction and left ventricular end‐systolic dimension index nomogram to estimate 1‐, 3‐, and 5‐year survival and to calculate the Aortic Regurgitation/Insufficiency Survival Estimation (ARISE) score. Calibration plots demonstrated good performance, with the area under the receiver operating characteristic curve reaching 0.79 in the validation data set. The left ventricular end‐systolic dimension index‐based nomogram showed similar performance. By using the tertiles of the ARISE score to risk stratify individuals, Kaplan‐Meier curves demonstrated significant survival differences among 3 risk groups in both the derivation and validation cohorts (P<0.001). Conclusions The ARISE score (https://arise‐score.vercel.app/), which includes guideline‐recommended parameters, effectively predicts survival in patients with aortic regurgitation. It may facilitate shared decision‐making between the heart team and patients. |
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| ISSN: | 2047-9980 |