Darlington Ashley, McCauley Mark D
Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.
Jesse Brown VA Medical Center, Chicago, IL, United States.
Front Cardiovasc Med. 2020 Feb 18;7:11. doi: 10.3389/fcvm.2020.00011. eCollection 2020.
The most dreaded complication of atrial fibrillation is stroke, and 70-80% of patients with AF-related stroke die or become disabled. The mechanisms of thromboembolism in AF are multifactorial, with evidence demonstrating that all three criteria of Virchow's triad are satisfied in AF: abnormal stasis of blood, endothelial damage, and hypercoagulability. Mechanistic insights into the latter two limbs have resulted in effective stroke prophylactic therapies (left atrial appendage occlusion and oral anticoagulants); however, despite these advances, there remains an excess of stroke in the AF population that may be due, in part, to a lack of mechanistic understanding of atrial hypocontractility resulting in abnormal stasis of blood within the atrium. These observations support the emerging concept of atrial cardiomyopathy as a cause of stroke. In this Review, we evaluate molecular, translational, and clinical evidence for atrial cardiomyopathy as a cause for stroke from AF, and present a rationale for further investigation of this largely unaddressed limb of Virchow's triad in AF.
心房颤动最可怕的并发症是中风，70%-80%的房颤相关性中风患者会死亡或致残。房颤血栓栓塞的机制是多因素的，有证据表明房颤满足了魏尔啸氏三联征的所有三个标准：血液异常淤滞、内皮损伤和高凝状态。对后两个因素的机制性认识带来了有效的中风预防疗法（左心耳封堵和口服抗凝药）；然而，尽管有这些进展，房颤人群中仍有过多的中风病例，这可能部分归因于对心房收缩功能减退导致心房内血液异常淤滞缺乏机制性认识。这些观察结果支持了心房心肌病作为中风病因这一新兴概念。在本综述中，我们评估了心房心肌病作为房颤所致中风病因的分子、转化和临床证据，并提出了进一步研究房颤中魏尔啸氏三联征这一基本未被关注因素的理论依据。
