Weerts Jerremy, Țica Otilia, Aranyo Julia, Basile Christian, Borizanova-Petkova Angelina, Borovac Josip Andjelo, Camilli Massimiliano, Eichenlaub Martin, Fiori Emiliano, Van Loon Tim, Withaar Coenraad, Zakarkaitė Diana, Zink Matthias D, Adamo Marianna, Aimo Alberto, Arbelo Elena, Bisbal Van Bylen Felipe, Farmakis Dimitrios T, Dobrev Dobromir, Čelutkienė Jelena, Böhm Michael, Coats Andrew, Metra Marco, Rosano Giuseppe, Ruschitzka Frank, Bayes-Genis Antoni, Kotecha Dipak
Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht, University Medical Centre, Maastricht, The Netherlands.
Heart Institute, Germans Trias i Pujol University Hospital, Badalona, Spain.
Eur J Heart Fail. 2025 Aug 5. doi: 10.1002/ejhf.3782.
The importance of atrial cardiomyopathy (AtCM) as a specific clinical entity is increasingly recognized. Past definitions have varied, and the lack of consistent cut-offs for imaging parameters and biomarkers have limited clinical utility to diagnose and track AtCM progression. While research has mainly focused on AtCM in the context of atrial fibrillation, emerging evidence underscores its relevance in remodelling and development of heart failure. The aim of this consensus document was to provide a contemporary framework for AtCM, evolve the definitions of AtCM and atrial failure for more widespread clinical use, and help to direct emerging research and future clinical trials. Supporting the work of early career researchers, this consensus document evaluates diagnostic markers and summarizes the underpinning mechanisms, clinical characteristics and prognostic impact of AtCM. Our objective was to bring together new translational scientific progress, catalyse future research and enable clinical application to facilitate better management, for example in patient groups where aggressive control of risk factors or comorbidities could prevent AtCM progression. We redefined AtCM as a graded disorder that includes electrical dysfunction of the atria along with evidence of either mechanical atrial dysfunction, atrial enlargement and/or atrial fibrosis. Atrial failure is the end-stage manifestation of AtCM, characterized by progressive structural, electrophysiological and functional changes. Earlier identification, risk stratification and ongoing research into therapeutic options have the potential to prevent the clinical consequences of AtCM and atrial failure, including adverse patient outcomes and poor quality of life associated with atrial fibrillation and heart failure.
心房心肌病（AtCM）作为一种特定的临床实体，其重要性日益得到认可。过去的定义各不相同，且成像参数和生物标志物缺乏一致的临界值，限制了其在诊断和追踪AtCM进展方面的临床应用。虽然研究主要集中在心房颤动背景下的AtCM，但新出现的证据强调了其在心力衰竭重塑和发展中的相关性。本共识文件的目的是为AtCM提供一个当代框架，完善AtCM和心房衰竭的定义以更广泛地应用于临床，并有助于指导新出现的研究和未来的临床试验。为支持早期职业研究人员的工作，本共识文件评估了诊断标志物，并总结了AtCM的潜在机制、临床特征和预后影响。我们的目标是整合新的转化科学进展，推动未来研究，并实现临床应用以促进更好的管理，例如在积极控制危险因素或合并症可预防AtCM进展的患者群体中。我们将AtCM重新定义为一种分级疾病，包括心房电功能障碍以及心房机械功能障碍、心房扩大和/或心房纤维化的证据。心房衰竭是AtCM的终末期表现，其特征为进行性的结构、电生理和功能改变。早期识别、风险分层以及对治疗选择的持续研究有可能预防AtCM和心房衰竭的临床后果，包括与心房颤动和心力衰竭相关的不良患者结局及生活质量不佳。
