Atrial Cardiomyopathy in Valvular Heart Disease: From Molecular Biology to Clinical Perspectives

• Published in: Cells (Basel, Switzerland) Switzerland), 2023-07, Vol.12 (13), p.1796
• Main Authors: Molnár, Andrea Ágnes, Sánta, Attila, Pásztor, Dorottya Tímea, Merkely, Béla
• Format: Article
• Language: English
• Subjects: Analysis; aortic valve stenosis; Arrhythmia; atrial cardiomyopathy; Atrial Fibrillation; Biomarkers; Cardiac arrhythmia; Cardiomyocytes; Cardiomyopathies - complications; Cardiomyopathy; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Collagen; Congestive heart failure; Diagnosis; Echocardiography; Electrophysiology; Enlargement; Extracellular matrix; Fibroblasts; Fibrosis; Growth factors; Heart diseases; Heart failure; Heart Failure - complications; Heart valve diseases; Heart Valve Diseases - complications; Heart Valve Diseases - drug therapy; Hemodynamics; Hormones; Humans; Inflammation; Kinases; Magnetic resonance imaging; mitral valve regurgitation; Molecular Biology; Myopathy; Oxidative stress; Pathophysiology; Peptides; Physiology, Pathological; Review; Risk factors; Serology; Structure-function relationships; Tachyarrhythmia; Thrombosis
• ISSN: 2073-4409; 2073-4409
• DOI: 10.3390/cells12131796

This review discusses the evolving topic of atrial cardiomyopathy concerning valvular heart disease. The pathogenesis of atrial cardiomyopathy involves multiple factors, such as valvular disease leading to atrial structural and functional remodeling due to pressure and volume overload. Atrial enlargement and dysfunction can trigger atrial tachyarrhythmia. The complex interaction between valvular disease and atrial cardiomyopathy creates a vicious cycle of aggravating atrial enlargement, dysfunction, and valvular disease severity. Furthermore, atrial remodeling and arrhythmia can predispose to atrial thrombus formation and stroke. The underlying pathomechanism of atrial myopathy involves molecular, cellular, and subcellular alterations resulting in chronic inflammation, atrial fibrosis, and electrophysiological changes. Atrial dysfunction has emerged as an essential determinant of outcomes in valvular disease and heart failure. Despite its predictive value, the detection of atrial fibrosis and dysfunction is challenging and is not included in the clinical routine. Transthoracic echocardiography and cardiac magnetic resonance imaging are the main diagnostic tools for atrial cardiomyopathy. Recently published data have revealed that both left atrial volumes and functional parameters are independent predictors of cardiovascular events in valvular disease. The integration of atrial function assessment in clinical practice might help in early cardiovascular risk estimation, promoting early therapeutic intervention in valvular disease.