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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| Language: | English |
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Wiley
2025-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039169 |
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| author | Kang Liu Meng‐Han Tsai Wei‐Jyun Wang Jui Wang Seanson Chance Ju Masashi Amano Chisato Izumi Yi‐Lwun Ho Masaaki Takeuchi Li‐Tan Yang |
| author_facet | Kang Liu Meng‐Han Tsai Wei‐Jyun Wang Jui Wang Seanson Chance Ju Masashi Amano Chisato Izumi Yi‐Lwun Ho Masaaki Takeuchi Li‐Tan Yang |
| author_sort | Kang Liu |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-d7772200f29443ef8ac8bc4d652ccdcd |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-d7772200f29443ef8ac8bc4d652ccdcd2025-08-20T03:07:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-05-01141010.1161/JAHA.124.039169Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE ScoreKang Liu0Meng‐Han Tsai1Wei‐Jyun Wang2Jui Wang3Seanson Chance Ju4Masashi Amano5Chisato Izumi6Yi‐Lwun Ho7Masaaki Takeuchi8Li‐Tan Yang9Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei TaiwanDepartment of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei TaiwanDepartment of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei TaiwanInstitute of Epidemiology and Prevention Medicine National Taiwan University Taipei TaiwanDepartment of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei TaiwanDepartment of Heart Failure and Transplantation National Cerebral and Cardiovascular Center Osaka JapanDepartment of Heart Failure and Transplantation National Cerebral and Cardiovascular Center Osaka JapanDepartment of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei TaiwanDepartment of Laboratory and Transfusion Medicine Hospital of University of Occupational and Environmental Health, School of Medicine Kitakyushu JapanDepartment of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei TaiwanBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.124.039169all‐cause mortalityaortic regurgitationARISE scoreclinical decision support systemnomogram |
| spellingShingle | Kang Liu Meng‐Han Tsai Wei‐Jyun Wang Jui Wang Seanson Chance Ju Masashi Amano Chisato Izumi Yi‐Lwun Ho Masaaki Takeuchi Li‐Tan Yang Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE Score Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease all‐cause mortality aortic regurgitation ARISE score clinical decision support system nomogram |
| title | Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE Score |
| title_full | Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE Score |
| title_fullStr | Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE Score |
| title_full_unstemmed | Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE Score |
| title_short | Nomogram for Predicting 1‐, 3‐, and 5‐Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE Score |
| title_sort | nomogram for predicting 1 3 and 5 year survival in hemodynamically significant aortic regurgitation the arise score |
| topic | all‐cause mortality aortic regurgitation ARISE score clinical decision support system nomogram |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.039169 |
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