Atrial cardiomyopathy (AC) is currently defined as “any complex of structural, architectural,
contractile or electrophysiological changes affecting the atria with the potential
to produce clinically-relevant manifestations” [
[1]
]. This clinical entity has recently gained relevance for a number of reasons. First,
it is well known that AC contributes to atrial fibrillation (AF)-related thromboembolism.
Indeed, several AC markers (e.g.: left atrial [LA] size and geometry, LA appendage
shape and function, spontaneous echo contrast, LA fibrosis, biomarkers of myocardial
stress and injury, epicardial fat, etc.) are associated with an increased risk of
stroke in AF patients [
[2]
,
[3]
]. Secondly, AC might be responsible for a proportion of strokes occurring in patients
without rhythm disturbances. In a secondary analysis of the NAVIGATE ESUS randomized
controlled trial, Healey et al. [
[4]
] showed that oral anticoagulants (OACs) reduced the risk of recurrent stroke in patients
with embolic stroke of undetermined source (ESUS) and moderate or severe LA enlargement.
Similarly, other evidences of abnormal atrial substrate (e.g.: LA and LA appendage
function, LA fibrosis on cardiac magnetic resonance imaging [MRI], and P-wave terminal
force in ECG lead V1) have been found associated with incident stroke [
[5]
]. In a EHRA/HRS/APHRS/SOLAECE consensus document [
[1]
], four classes of AC were identified: (i) principal cardiomyocyte changes; (ii) principally
fibrotic changes; (iii) combined cardiomyocyte-pathology/fibrosis; and (iv) primarily
non-collagen infiltration (with or without cardiomyocyte changes). Although useful,
this classification is based only on histopathologic findings, which is a limit to
its large-scale applicability. Several parameters that can more easily assessed, such
as echocardiography measurements, MRI findings, ECG findings, biomarkers levels, and
invasive electro-anatomic mapping have been proposed for AC diagnosis, but their role
needs to be further elucidated.Keywords
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Article info
Publication history
Published online: May 20, 2022
Accepted:
May 16,
2022
Received:
May 11,
2022
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
