Tao Si-Ming, Yang Man
Department of Cardiology, The Affiliated Hospital of Yunnan University, 650021 Kunming, Yunnan, China.
Department of Cardiology, The First People's Hospital of Dali, 671000 Dali, Yunnan, China.
Rev Cardiovasc Med. 2025 Apr 30;26(5):26897. doi: 10.31083/RCM26897. eCollection 2025 May.
Clinical observations have shown that cases of stroke or thromboembolism are not uncommon even in the absence of atrial fibrillation, suggesting that atrial fibrillation is a delayed marker of atrial thrombus formation. Atrial cardiomyopathy (ACM) is a pathophysiological concept characterized by atrial substrate and functional abnormalities closely associated with atrial myopathy, atrial enlargement, and impaired ventricular diastolic function. It is an independent factor for thromboembolic stroke, increasing the risk of serious complications such as atrial fibrillation, heart failure, and sudden cardiac death. ACM is likely to be a potential cause of embolic stroke, especially cryptogenic stroke, and early identification of patients at high thromboembolic risk is essential to guide anticoagulation therapy. Although the pathogenesis of ACM has not been fully elucidated, prospective mechanism-based studies have revealed the important role of activated cardiac immune cells along with inflammatory responses, oxidative stress, and other factors in its progression. Exploring the role of immune regulation in the pathogenesis of ACM provides new insights into the underlying mechanisms of cerebrovascular events of cardiac thromboembolic origin. This review summarizes the mechanisms by which immune regulation is involved in the progression of ACM and provides useful insights for future clinical diagnosis and treatment.
临床观察表明，即使在没有心房颤动的情况下，中风或血栓栓塞病例也并不罕见，这表明心房颤动是心房血栓形成的一个延迟指标。心房心肌病（ACM）是一个病理生理概念，其特征是心房基质和功能异常，与心房肌病、心房扩大和心室舒张功能受损密切相关。它是血栓栓塞性中风的一个独立因素，会增加心房颤动、心力衰竭和心源性猝死等严重并发症的风险。ACM很可能是栓塞性中风的一个潜在原因，尤其是隐源性中风，早期识别高血栓栓塞风险的患者对于指导抗凝治疗至关重要。虽然ACM的发病机制尚未完全阐明，但基于机制的前瞻性研究已经揭示了活化的心脏免疫细胞以及炎症反应、氧化应激和其他因素在其进展中的重要作用。探索免疫调节在ACM发病机制中的作用，为心脏血栓栓塞性起源的脑血管事件的潜在机制提供了新的见解。本综述总结了免疫调节参与ACM进展的机制，并为未来的临床诊断和治疗提供了有益的见解。
