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Atrial Cardiomyopathy: An Unexplored Limb of Virchow's Triad for AF Stroke Prophylaxis

Ashley Darlington1,2, Mark D McCauley1,2,3

  • 1Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.

Frontiers in Cardiovascular Medicine
|March 6, 2020
PubMed

Insights

Atrial fibrillation (AF) increases stroke risk due to blood stasis, endothelial damage, and hypercoagulability. Atrial cardiomyopathy, causing blood stasis, is an understudied cause of AF-related stroke.

Area of Science:

  • Cardiology
  • Neurology
  • Thrombosis

Background:

  • Atrial fibrillation (AF) is a major cause of stroke, leading to high mortality and disability.
  • Stroke in AF patients is linked to Virchow's triad: blood stasis, endothelial damage, and hypercoagulability.
  • Current therapies target endothelial damage and hypercoagulability, but stroke risk persists.

Purpose of the Study:

  • To review evidence linking atrial cardiomyopathy to stroke in AF patients.
  • To explore atrial hypocontractility as a cause of blood stasis in AF.
  • To highlight the need for further research into atrial cardiomyopathy's role in AF-related stroke.

Main Methods:

  • Review of molecular, translational, and clinical studies.
  • Analysis of evidence supporting atrial cardiomyopathy as a stroke mechanism.
  • Evaluation of the role of atrial hypocontractility and blood stasis.

Main Results:

  • Atrial fibrillation satisfies all criteria of Virchow's triad.
  • Atrial hypocontractility contributes to blood stasis within the atrium.
  • Atrial cardiomyopathy is an emerging concept explaining residual stroke risk in AF.

Conclusions:

  • Atrial cardiomyopathy is a significant, under-addressed cause of stroke in atrial fibrillation.
  • Understanding atrial hypocontractility is crucial for developing new stroke prevention strategies.
  • Further investigation into atrial cardiomyopathy is warranted to reduce AF-related stroke burden.

Keywords:
Virchow's triadatrial cardiomyopathyatrial contractilityatrial fibrillationstroke

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