Left atrial cardiomyopathy: Pathophysiological insights, assessment methods and clinical implications.

[Display omitted] • ACM is characterized by histopathological and electrophysiological remodelling. • This remodelling leads to adverse clinical outcomes. • Several factors play a critical role in ACM pathogenesis. • These factors include aging, metabolic disorders, pressure overload and genetics. • Noninvasive clinical tools can characterize ACM. • These tools include electrocardiography, cardiac imaging and serum biomarkers. • The tools are helpful in the prediction of adverse clinical outcomes. • The outcomes include atrial fibrillation, stroke, heart failure and dementia. 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. [ABSTRACT FROM AUTHOR]