Karakasis Paschalis, Vlachakis Panayotis K, Theofilis Panagiotis, Ktenopoulos Nikolaos, Patoulias Dimitrios, Fyntanidou Barbara, Antoniadis Antonios P, Fragakis Nikolaos
Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Diagnostics (Basel). 2025 May 10;15(10):1207. doi: 10.3390/diagnostics15101207.
Atrial fibrillation (AF) is increasingly recognized as the clinical manifestation of an underlying atrial disease process rather than a purely electrical disorder. This evolving paradigm has given rise to the concept of atrial cardiomyopathy (AtCM), encompassing structural, electrical, contractile, and molecular remodeling of the atrial myocardium that contributes to AF initiation, maintenance, and progression. Although consensus definitions of AtCM now exist, its integration into clinical practice remains limited, with AF management still largely guided by arrhythmic patterns rather than substrate characterization. This review synthesizes current diagnostic strategies for AtCM within the context of AF, emphasizing a multimodal approach. We outline advances in cardiac imaging-including echocardiography, cardiac magnetic resonance, and computed tomography-for detailed assessment of atrial morphology, function, and fibrosis. Electroanatomic mapping is discussed as a key invasive tool for substrate localization, while electrocardiographic indices such as P-wave morphology and dispersion serve as accessible surrogates of electrical remodeling. In parallel, we examine the role of circulating biomarkers and emerging genomic, transcriptomic, and epigenomic markers in refining disease phenotyping. Despite promising progress, significant challenges remain. Standardization of imaging protocols, validation of biomarker thresholds, and integration of artificial intelligence tools are needed to enhance clinical utility. A diagnostic framework informed by atrial substrate assessment may support more tailored therapeutic decision-making in AF. Future research should prioritize the harmonization of diagnostic criteria and explore how substrate profiling in AF may refine risk stratification and improve clinical outcomes.
心房颤动（AF）越来越被认为是潜在心房疾病过程的临床表现，而非单纯的电紊乱。这种不断演变的范式催生了心房心肌病（AtCM）的概念，它涵盖了心房心肌的结构、电、收缩和分子重塑，这些重塑促成了房颤的起始、维持和进展。尽管现在存在AtCM的共识定义，但其在临床实践中的整合仍然有限，房颤的管理在很大程度上仍由心律失常模式而非基质特征来指导。本综述综合了房颤背景下AtCM的当前诊断策略，强调多模式方法。我们概述了心脏成像方面的进展，包括超声心动图、心脏磁共振成像和计算机断层扫描，用于详细评估心房形态、功能和纤维化。电解剖标测被视为基质定位的关键侵入性工具，而诸如P波形态和离散度等心电图指标可作为电重塑的便捷替代指标。同时，我们研究了循环生物标志物以及新兴的基因组、转录组和表观基因组标志物在完善疾病表型方面的作用。尽管取得了有前景的进展，但重大挑战依然存在。需要对成像方案进行标准化、验证生物标志物阈值并整合人工智能工具，以提高临床实用性。基于心房基质评估的诊断框架可能支持房颤治疗中更具针对性的决策制定。未来的研究应优先统一诊断标准，并探索房颤中的基质分析如何优化风险分层并改善临床结局。
