https://doi.org/10.1007/s00392-024-02526-y
1REGIOMED-KLINIKEN GmbH II. Medizinische Klinik - Kardiologie, Angiologie Coburg, Deutschland; 2REGIOMED-KLINIKEN GmbH II. Medizinische Klinik - Kardiologie, Angiologie, Pneumologie Coburg, Deutschland
Background:
Atrial myopathy, in particular atrial fibrosis, may initiate a vicious cycle in which atrial myopathy leads to atrial fibrillation (AF), which in turn leads to a worsening myopathy. The development of atrial myopathy is complex with multiple factors contributing to its development.
Aim:
The aim of this study was to identify factors that are associated with the development of atrial myopathy in patients without atrial fibrillation.
Methods and results:
Sixty-five consecutive patients (40 male, 57.8 ±13.6 years old) with normal sinus rhythm (NSR) and without a history of atrial fibrillation (AF) underwent LGE-MRI to assess for LA-Fibrosis. Each LGE-MRI was segmented by isolation the LA wall and quantified for the relative extent of fibrotic remodeling using the Corview software (Marrek Inc.). The comorbidities were documented and their correlation with the degree of left atrial fibrosis was investigated through the implementation of univariate and multivariate analyses. The mean degree of left atrial (LA) fibrosis among individuals without AF was 13.6 ± 7.6 percent. The prevalence of LA-Fibrosis varies between 2.6% and 34.7%. In the univariate analysis, mitral valve regurgitation (p=0.007), congestive heart failure (p=0.026), LA-Volume (p<0.001), and Weight (p=0.010) were all significantly associated with the extent of left atrial fibrosis. The significance of LA-Volume (p=0.0122) is maintained in multivariable analysis.
Conclusion:
This study concludes that a substantial proportion of patients without a prediagnosed AF have structural fibrotic alterations prior to the onset of atrial fibrillation, as evidenced by the high prevalence of atrial fibrosis among non-AF patients. There appears to be an association between the development of atrial cardiomyopathy and a range of cardiac and non-cardiac comorbidities. As a result, routine monitoring for atrial fibrillation should be considered in these patients.