J Cardiovasc Ultrasound.  2017 Sep;25(3):84-90. 10.4250/jcu.2017.25.3.84.

Associates and Prognosis of Giant Left Atrium; Single Center Experience

• Kim H
• Park YA
• Choi SM
• Chung H
• Kim JY
• Min PK
• Yoon YW
• Lee BK
• Hong BK
• Rim SJ
• Kwon HM
• Choi EY

• KMID: 2392253
• DOI: http://doi.org/10.4250/jcu.2017.25.3.84

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.

Keyword

Left atrium; Remodeling; Cardiovascular events; Echocardiography

MeSH Terms

Atrial Fibrillation
Blood Pressure
Echocardiography
Follow-Up Studies
Heart Atria*
Humans
Mitral Valve
Mitral Valve Insufficiency
Mitral Valve Stenosis
Multivariate Analysis
Prognosis*
Prolapse
Tertiary Care Centers

Figure

• 

  Fig. 1 Schematic flow diagram of the study population. TTE: transthoracic echocardiography, MR: mitral regurgitation, MS: mitral stenosis, MV: mitral valve, MVD: mitral valvular disease, RHD: rheumatic heart disease.

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  Fig. 2 Representative cases of a giant LA. Parasternal long axis view (A) and apical 4-chamber view (B) of rheumatic mitral stenosis. Parasternal long axis view (C) and apical 4-chamber view (D) of hypertrophic cardiomyopathy with moderate MR. Parasternal long axis view (E) and apical 4-chamber view (F) of severe rheumatic MR. Dotted line in C shows antero-posterior diameter of left atrium. LA: left atrium, MR: mitral regurgitation.

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