Associates and Prognosis of Giant Left Atrium; Single Center Experience
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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.
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.
참고문헌 (21)
- Abhayaratna WP, "Left atrial size: physiologic determinants and clinical applications", J Am Coll Cardiol, 47, pp.2357~2363 (2006)
- De Jong AM, "Mechanisms of atrial structural changes caused by stretch occurring before and during early atrial fibrillation", Cardiovasc Res, 89, pp.754~765 (2011)
- Gerdts E, "Left atrial size and risk of major cardiovascular events during antihypertensive treatment: losartan intervention for endpoint reduction in hypertension trial", Hypertension, 49, pp.311~316 (2007)
- Manning WJ, "Left atrial size and postoperative atrial fibrillation: the volume of evidence suggests it is time to break an old habit", J Am Coll Cardiol, 48, pp.787~789 (2006)
- Laukkanen JA, "Left atrium size and the risk of cardiovascular death in middle-aged men", Arch Intern Med, 165, pp.1788~1793 (2005)
- El Maghraby A, "Giant left atrium: a review", Heart Views, 13, pp.46~52 (2012)
- Apostolakis E, "The surgical management of giant left atrium", Eur J Cardiothorac Surg, 33, pp.182~190 (2008)
- Oh JK, "Echocardiographic evaluation of morphological and hemodynamic significance of giant left atrium. An important lesson", Circulation, 86, pp.328~330 (1992)
- Lang RM, "Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging", Eur Heart J Cardiovasc Imaging, 16, pp.233~270 (2015)
- Aurigemma GP, "Left atrial volume and geometry in healthy aging: the Cardiovascular Health Study", Circ Cardiovasc Imaging, 2, pp.282~289 (2009)
- Jiamsripong P, "Three methods for evaluation of left atrial volume", Eur J Echocardiogr, 9, pp.351~355 (2008)
- Grayburn PA, "Quantitation of mitral regurgitation", Circulation, 126, pp.2005~2017 (2012)
- Nishimura RA, "2014 AHA", ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology, Circulation, pp.2014, 129[DOI]
- Plaschkes J, "Giant left atrium in rheumatic heart disease: a report of 18 cases treated by mitral valve replacement", Ann Surg, 174, pp.194~201 (1971)
- Johnson J, "Plication of the giant left atrium at operation for severe mitral regurgitation", Surgery, 61, pp.118~121 (1967)
- Qian Y, "Different structural remodelling in atrial fibrillation with different types of mitral valvular diseases", Europace, 12, pp.371~377 (2010)
- Wang L, "A comprehensive genetic study on left atrium size in Caribbean Hispanics identifies potential candidate genes in 17p10", Circ Cardiovasc Genet, 3, pp.386~392 (2010)
- Matsuda H, "The causes of prolonged postoperative respiratory care in mitral valve disease with a giant left atrium", Kyobu Geka, 43, pp.172~177 (1990)
- Kawazoe K, "Surgical treatment of giant left atrium combined with mitral valvular disease. Plication procedure for reduction of compression to the left ventricle, bronchus, and pulmonary parenchyma", J Thorac Cardiovasc Surg, 85, pp.885~892 (1983)
- Tsang TS, "Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?", J Am Coll Cardiol, 47, pp.1018~1023 (2006)
- Mahabadi AA, "Quantitative assessment of left atrial volume by electrocardiographic-gated contrast-enhanced multidetector computed tomography", J Cardiovasc Comput Tomogr, 3, pp.80~87 (2009)