A lower aorto-mitral angle was significantly associated with a higher likelihood of prosthetic mitral valve deterioration (OR 1.08, p<0.001), particularly for angles <116° (OR 12, p=0.001).
Case-Control (n=205)
Does the aorto-mitral angle predict prosthetic mitral valve deterioration in patients undergoing mitral valve replacement?
A lower aorto-mitral angle, particularly <125°, is a significant geometric predictor of prosthetic mitral valve deterioration following mitral valve replacement.
Effect estimate: OR 1.08
p-value: p=<0.001
Abstract Background Prosthetic mitral valve deterioration (PVD) is a major cause of valve dysfunction and reintervention, affecting long-term outcomes following mitral valve replacement, approximately 6% patients-year. The aorto-mitral angle (AMA) has emerged as a potential determinant of valve performance and longevity. However, its role in predicting PVD following mitral valve replacement remains underexplored. Purpose This study aimed to evaluate the relationship between AMA and mitral prosthetic valve deterioration, identify additional clinical predictors of prosthetic valve deterioration (PVD), and define an optimal AMA cutoff for predicting PVD. Methods A retrospective case-control study was conducted on patients undergoing bioprosthetic or mechanical mitral valve replacement between January 1985 and June 2024. Cases comprised patients with PVD confirmed via transthoracic echocardiography, while controls had no evidence of deterioration. AMA measurements were derived from echocardiographic imaging. Statistical analyses, including logistic regression, were performed to assess associations between AMA and valve deterioration. Results A total of 205 patients were included (58 cases and 147 controls). Cases exhibited a significantly lower AMA (122.63 ± 7.70°) compared to controls (127.69 ± 8.05°, p 0.001). A lower AMA was associated with a higher likelihood of PVD (OR = 1.08, p 0.001). In a subgroup analysis of bioprosthetic valves, the PVD group had a lower AMA (119.82 ± 7.10°) compared to controls (125.63 ± 7.48°, p = 0.001; OR = 1.10, p = 0.001). An AMA of less than 116° was strongly associated with PVD (OR = 12, p = 0.001). The optimal AMA cutoff for predicting PVD was 125°. Conclusion The aorto-mitral angle (AMA) is a significant geometric predictor of prosthetic mitral valve deterioration (PVD). Lower AMAs, particularly values below 116°, were strongly associated with PVD across all types of mitral valve replacement, especially in bioprosthetic valves. These findings suggest that optimizing AMA during valve replacement surgery could improve prosthetic valve longevity and patient outcomes. Further prospective studies are warranted to validate these results.Logistic regression analysis subgroupAMA Event-free survival analysis
Changklungkul et al. (Sat,) conducted a case-control in Prosthetic mitral valve deterioration (n=205). Aorto-mitral angle (AMA) was evaluated on Prosthetic mitral valve deterioration (PVD) (OR 1.08, p=<0.001). A lower aorto-mitral angle was significantly associated with a higher likelihood of prosthetic mitral valve deterioration (OR 1.08, p<0.001), particularly for angles <116° (OR 12, p=0.001).