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Left atrial cardiomyopathy: Pathophysiological insights, assessment methods and clinical implications
Sandro Ninni1, Vincent Algalarrondo2, Fabien Brette3
1CHU de Lille, Université de Lille, 59000 Lille, France.
Insights
Atrial cardiomyopathy involves complex changes in the atria, impacting heart health. Understanding these mechanisms and using diagnostic tools can help predict conditions like atrial fibrillation and stroke.
Area of Science:
- Cardiology
- Electrophysiology
- Pathophysiology
Background:
- Atrial cardiomyopathy encompasses structural, contractile, and electrical changes in the atria.
- Current understanding largely stems from animal models and atrial fibrillation patient samples.
- Noninvasive tools show promise for risk stratification of atrial fibrillation and related outcomes.
Purpose of the Study:
- To provide an overview of atrial cardiomyopathy's pathophysiological mechanisms.
- To discuss the interplay of factors like aging, pressure overload, metabolic, and genetic influences.
- To review current clinical tools for characterization and discuss clinical impact.
Main Methods:
- Literature review of pathophysiological mechanisms.
- Discussion of contributing factors: aging, pressure overload, metabolic disorders, genetics.
- Analysis of clinical tools: ECG, cardiac imaging, biomarkers.
Main Results:
- Atrial cardiomyopathy pathogenesis involves a complex interplay of multiple factors.
- Various noninvasive tools can characterize atrial cardiomyopathy.
- Atrial cardiomyopathy is linked to increased risk of atrial fibrillation, stroke, heart failure, and dementia.
Conclusions:
- A clinically relevant definition of atrial cardiomyopathy is crucial for improved treatment.
- Understanding atrial cardiomyopathy mechanisms aids in predicting adverse cardiovascular events.
- Further research is needed to refine diagnostic and therapeutic strategies.
Abstract:
Atrial cardiomyopathy is defined as any complex of structural, architectural, contractile or electrophysiological changes affecting atria, with the potential to produce clinically relevant manifestations. Most of our knowledge about the mechanistic aspects of atrial cardiomyopathy is derived from studies investigating animal models of atrial fibrillation and atrial tissue samples obtained from individuals who have a history of atrial fibrillation. Several noninvasive tools have been reported to characterize atrial cardiomyopathy in patients, which may be relevant for predicting the risk of incident atrial fibrillation and its related outcomes, such as stroke. Here, we provide an overview of the pathophysiological mechanisms involved in atrial cardiomyopathy, and discuss the complex interplay of these mechanisms, including aging, left atrial pressure overload, metabolic disorders and genetic factors. We discuss clinical tools currently available to characterize atrial cardiomyopathy, including electrocardiograms, cardiac imaging and serum biomarkers. Finally, we discuss the clinical impact of atrial cardiomyopathy, and its potential role for predicting atrial fibrillation, stroke, heart failure and dementia. Overall, this review aims to highlight the critical need for a clinically relevant definition of atrial cardiomyopathy to improve treatment strategies.
