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Associates and prognosis of giant left atrium; single center experience
Hyoeun Kim1, Young-Ah Park2, Sung Min Choi1, Hyemoon Chung3, Jong-Youn Kim1, Pil-Ki Min1, Young Won Yoon1, Byoung Kwon Lee1, Bum-Kee Hong1, Se-Joong Rim1, Hyuck Moon Kwon1, Eui-Young Choi1*
1Gangnam Severance Hospital Division of Cardiology
2Inje University College of Medicine
3Kyung Hee University College of Medicine
Corresponding Author: Eui-Young Choi ,Email: choi0928@yuhs.ac
ABSTRACT
BACKGROUND: Left atrial (LA) remodeling develops as a result of longstanding pressure overload. However, determinants and clinical outcome of excessive remodeling, so called giant left atrium (GLA), are not clear. METHODS: Clinical characteristics of patients with GLA (anterior-posterior diameter higher than 65 mm), including echo-Doppler parameters, and follow-up clinical outcomes from a tertiary referral hospital were investigated. RESULTS: Among 68,519 consecutive primary patients who underwent echocardiography over a period of 10 years, data from 163 GLA cases (0.24%) were analyzed. Main causes were significant rheumatic mitral stenosis (n=58, 36%); other causes comprised significant rheumatic mitral regurgitation (MR; n=10, 6%), mitral valve (MV) prolapse or congenital MV disease (n=20, 12%), and functional MR (n=25, 15%). However, mild rheumatic MV disease (n=4, 3%) or left ventricular (LV) systolic or diastolic dysfunction without significant MR (n=46, 28%) were also causes of GLA. During median follow-up of 22 months, 42 cases (26%) underwent composite events. Mitral valve surgery was related to lower rate of composite events. In multivariate analysis, mitral valve surgery, elevated pulmonary arterial systolic pressure, and increased LA volume index were independent predictors of future events (p<0.05) regardless of underlying diseases or history of MV surgery. CONCLUSION: Although rheumatic MV disease with atrial fibrillation is the main contributor to GLA, advanced LV diastolic dysfunction combined with atrial fibrillation also could be related to GLA. Even in GLA state, accurate measurement of LA volume is crucial for risk stratification for future events, regardless of underlying disease.
Keywords: Left atrium, Remodeling, Cardiovascular events, Echocardiography
Volume 25, No 3
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