Physiologic Markers of Mortality in Acute Valve Syndrome: An Ischemic Physiology Score Stratifies Patient Risk.

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%; 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.