Left Atrial Remodeling in Segmental vs. Global Mitral Valve Prolapse　- Three-Dimensional Echocardiography.
Segmental and global mitral valve prolapse (MVP) comprise 2 representative phenotypes in this syndrome. While mitral regurgitation (MR) severity is a major factor causing left atrial (LA) remodeling in MVP, prominent mitral valve (MV) annulus dilatation in global MVP may specifically cause inferiorly predominant LA remodeling. We compared MV annulus and LA geometry in patients with segmental and global MVP.



LA volume as well as inferior, middle, and superior LA cross-sectional areas (CSA) were measured on 3-D echocardiography in 20 controls, in 40 patients with segmental MVP, and in 18 with global MVP. On multivariate analysis, MR severity was primarily associated with LA dilatation in segmental MVP (P<0.001), while MV annular dilatation was primarily associated with LA dilatation in global MVP (P<0.001). Although there was no regional predominance in LA dilatation in segmental MVP, inferior predominance of LA dilatation was significant in global MVP (increase in inferior, middle, and superior LA-CSA relative to mean of the controls: +220±70% vs. +171±55% vs. +137±37%, P<0.001).



LA remodeling in segmental and global MVP is considerably different regarding its association with MR volume or MV annular dilatation and its regional predominance. While MR volume may mainly contribute to LA remodeling in segmental MVP, MV annular dilatation seems to have an important role in LA remodeling in global MVP. (Circ J 2016; 80: 2533-2540).
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine.
Atsushi
A
Hayashi
Shota
S
Fukuda
Keitaro
K
Mahara
Soshi
S
Hei
Takeshi
T
Onoue
Yuichiro
Y
Kado
Yasufumi
Y
Nagata
Mai
M
Iwataki
Kyoko
K
Otani
Tetsu
T
Miyamoto
Yasushi
Y
Oginosawa
Shinjo
S
Sonoda
Masataka
M
Eto
Yosuke
Y
Nishimura
Shuichiro
S
Takanashi
Robert A
RA
Levine
Yutaka
Y
Otsuji
D000368:Aged; D000369:Aged, 80 and over; D064752:Atrial Remodeling; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011446:Prospective Studies