Journal of IMAB
Publisher: Peytchinski Publishing Ltd.
ISSN:
1312-773X (Online)
Issue:
2024, vol. 30, issue2
Subject Area:
Medicine
-
DOI:
10.5272/jimab.2024302.5597
Published online: 26 June 2024
Review article
J of IMAB. 2024 Apr-Jun;30(2):5597-5600
ATRIAL CARDIOMYOPATHY AND STROKE PREVENTION - REVIEW
Blagovest Stoimenov, Ralitsa Pancheva,
Department of propaedeutics of internal diseases, UMHAT "Alexandrovska"; Medical Faculty, Medical University - Sofia, Bulgaria.
ABSTRACT:
Atrial cardiomyopathy (ACM) represents a novel paradigm in cardiovascular medicine, encompassing structural and functional changes within the atria that contribute to adverse clinical outcomes, notably stroke. This review explores the multifaceted implications of ACM, particularly its relevance independent of atrial fibrillation (AF) and its potential applications in stroke prevention and management. Advancements in imaging modalities, notably speckle-tracking echocardiography, offer valuable insights into atrial remodeling and dysfunction, facilitating early detection of ACM. Markers such as P-wave terminal force, NT-proBNP levels, and left atrial dimensions serve as diagnostic indicators for ACM, aiding in risk stratification in individuals devoid of AF history. Ischemic strokes are one of the most common causes of cardiovascular morbidity and mortality. A significant proportion of patients with ischemic stroke are suspected of embolic stroke without a specific embolic source being found (ESUS). The most recent related clinical trials evaluated tailored anticoagulation strategies in ACM-associated stroke, signaling a shift beyond conventional AF management. In conclusion, ACM emerges as a pivotal concept in stroke prevention, offering opportunities for personalized interventions and refined risk stratification beyond AF.
Keywords: Atrial Cardiomyopathy, Atrial fibrillation, Stroke prevention, Embolic stroke of undetermined source, LA strain,
- Download FULL TEXT /PDF 576 KB/
Please cite this article as: Stoimenov B, Pancheva R. Atrial Cardiomyopathy and stroke prevention - review. J of IMAB. 2024 Apr-Jun;30(2):5597-5600. [Crossref - 10.5272/jimab.2024302.5597]
Correspondence to: Blagovest Stoimenov, Department of Propaedeutics of internal diseases, UMHAT "Alexandrovska"; Medical Faculty, Medical University - Sofia; 1, Georgi Sofiiski Str.,Sofia, Bulgaria; E-mail: stoimenov90@gmail.com
REFERENCES:
1. Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016 Oct;18(10):1455-1490. [PubMed]
2. Brigden W. Uncommon myocardial diseases: the non-coronary cardiomyopathies. Lancet. 1957 Dec 21;273(7008):1243-9. [PubMed]
3. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006 Apr 11;113(14):1807-16. [PubMed]
4. Guichard JB, Nattel S. Atrial Cardiomyopathy: A Useful Notion in Cardiac Disease Management or a Passing Fad? J Am Coll Cardiol. 2017 Aug 8;70(6):756-765. [PubMed]
5. Brambatti M, Connolly SJ, Gold MR, Morillo CA, Capucci A, Muto C, et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014 May 27;129(21):2094-9. [PubMed]
6. Hausfater P, Costedoat-Chalumeau N, Amoura Z, Cacoub P, Papo T, Grateau G, et al. AL cardiac amyloidosis and arterial thromboembolic events. Scand J Rheumatol. 2005 Jul-Aug;34(4):315-9. [PubMed]
7. Kessler Iglesias C, Pouliopoulos J, Thomas L, Hayward CS, Jabbour A, Fatkin D. Atrial cardiomyopathy: Current and future imaging methods for assessment of atrial structure and function. Front Cardiovasc Med. 2023 Mar 31;10:1099625. [PubMed]
8. Blume GG, Mcleod CJ, Barnes ME, Seward JB, Pellikka PA, Bastiansen PM, et al. Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr. 2011 Jun;12(6):421-30. [PubMed]
9. Shah AM, Shah SJ, Anand IS, Sweitzer NK, O'Meara E, Heitner JF, et al. Cardiac structure and function in heart failure with preserved ejection fraction: baseline findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. Circ Heart Fail. 2014 Jan;7(1):104-15. [PubMed]
10. Gan GCH, Kadappu KK, Bhat A, Fernandez F, Gu KH, Cai L, et al. Left Atrial Strain Is the Best Predictor of Adverse Cardiovascular Outcomes in Patients with Chronic Kidney Disease. J Am Soc Echocardiogr. 2021 Feb;34(2):166-175. [PubMed]
11. Eichenlaub M, Mueller-Edenborn B, Minners J, Allgeier M, Lehrmann H, Allgeier J, et al. Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation. Clin Res Cardiol. 2021 Nov;110(11):1770-1780. [PubMed]
12. Eichenlaub M, Mueller-Edenborn B, Minners J, Jander N, Allgeier M, Lehrmann H, et al. Left Atrial Hypertension, Electrical Conduction Slowing, and Mechanical Dysfunction - The Pathophysiological Triad in Atrial Fibrillation-Associated Atrial Cardiomyopathy. Front Physiol. 2021 Aug 5;12:670527. [PubMed]
13. Mirza M, Caracciolo G, Khan U, Mori N, Saha SK, Srivathsan K, et al. Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study. J Interv Card Electrophysiol. 2011 Sep;31(3):197-206. [PubMed]
14. Wolsk E, Lamberts M, Hansen ML, Blanche P, Køber L, Torp-Pedersen C, et al. Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm: a nationwide cohort study. Eur J Heart Fail. 2015 Aug;17(8):828-36. [PubMed]
15. Belen E, Ozal E, Pusuroglu H. Association of the CHA2DS2-VASc score with left atrial spontaneous echo contrast: a cross-sectional study of patients with rheumatic mitral stenosis in sinus rhythm. Heart Vessels. 2016 Sep;31(9):1537-43. [PubMed]
16. Calenda BW, Fuster V, Halperin JL, Granger CB. Stroke risk assessment in atrial fibrillation: risk factors and markers of atrial myopathy. Nat Rev Cardiol. 2016 Sep;13(9):549-59. [PubMed]
17. Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020 Oct 1;383(14):1305-1316. [PubMed]
18. Kamel H, Bartz TM ,Elkind MSV, Okin P, Thacker E, Patton K, et al. Atrial cardiopathy and the risk of ischemic stroke in the CHS (Cardiovascular Health Study). Stroke. 2018 Apr;49(4):980-986. [PubMed]
19. Marcus GM, Ovbiagele B. Anticoagulation for Atrial Cardiopathy in Cryptogenic Stroke. JAMA. 2024 Feb 20;331(7):564-566. [PubMed]
20. Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic stroke: research and practice. Circ Res. 2017 Feb 3;120(3):527-540. [PubMed]
21. Hart RG, Sharma M, Mundl H, Kasner S, Bangdiwala S, Berkowitz S, et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. 2018 Jun 7;378(23):2191-2201. [PubMed]
22. Diener H C, Sacco RL, Easton JD, Granger C, Bernstein R, Uchiyama S, et al. Dabigatran for prevention of stroke after embolic stroke of undetermined source N Engl J Med. 2019 May 16;380(20):1906-1917. [PubMed]
23. Kamel H, Longstreth WT Jr, Tirschwell DL, Kronmal RA, Marshall RS, Broderick JP, et al. Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy: The ARCADIA Randomized Clinical Trial. JAMA. 2024 Feb 20;331(7):573-581. [PubMed]
24. Healey JS, Gladstone DJ, Swaminathan B, Eckstein J, Mundl H, Epstein AE, et al. Recurrent stroke with rivaroxaban compared with aspirin according to predictors of atrial fibrillation: secondary Analysis of the NAVIGATE ESUS randomized clinical trial. JAMA Neurol. 2019 Jul 1;76(7):764-73. [PubMed]
25. Nguyen HT, Nguyen HVB ,Nguyen HQ, Le HQ. Prevalence of left atrial appendage thrombus in patients with acute ischaemic stroke and sinus rhythm: across-sectional study. BMJ Open. 2021 Dec 17;11(12):e051563. [PubMed]
26. Hart RG, Diener H-C, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014 Apr;13(4):429-38. [PubMed]
27. Ntaios G. Embolic stroke of undetermined source: JACC review topic of the week. J Am Coll Cardiol. 2020 Jan 28;75(3):333-340. [PubMed]
Received: 26 February 2024
Published online: 26 June 2024
back to Online Journal