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JCU 2017 September;25(3) :84-90.
Published online 2017 September 28.
Associates and Prognosis of Giant Left Atrium; Single Center Experience
Hyoeun Kim, MD1*, Young-Ah Park, MD2*, Sung Min Choi, MD1, Hyemoon Chung, MD3, Jong-Youn Kim, MD, PhD1, Pil-Ki Min, MD, PhD1, Young Won Yoon, MD, PhD1, Byoung Kwon Lee, MD, PhD1, Bum-Kee Hong, MD, PhD1, Se-Joong Rim, MD, PhD1, Hyuck Moon Kwon, MD1, and Eui-Young Choi, MD, PhD1
1Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
2Division of Cardiology, Inje University College of Medicine, Busan, Korea
3Division of Cardiology, Kyung Hee University School of Medicine, Seoul, Korea
Corresponding Author: Eui-Young Choi ,Tel: +82-2-2019-3310, Fax: +82-2-3463-3882, 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 (antero-posterior diameter higher than 65 mm), including echo-Doppler parameters, and follow-up clinical outcomes from a tertiary referral hospital were investigated.
Results:
Among 68519 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 mitral valvular disease (MVD) (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. MV surgery was related to lower rate of composite events. In multivariate analysis, MV 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 MVD with atrial fibrillation is the main contributor to GLA, longstanding atrial fibrillation with LV dysfunction but without MVD 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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