Atrial cardiomyopathy in the focus of modern cardiology (lecture)

To analyze the current state of knowledge about the pathophysiology, diagnosis, and treatment of atrial cardiomyopathy based on recent scientific research and clinical guidelines, examining emerging therapeutic strategies, prognostic implications, and future research directions in this rapidly evolving field. Main findings: Atrial Cardiomyopathy (AC) represents a complex pathophysiological concept that describes structural, architectural, contractile, or electrophysiological changes in the atria with the potential for clinically significant manifestations. Since the first consensus statement in 2016, the number of publications on this topic has grown exponentially, reflecting increasing clinical interest in the problem and growing recognition of its clinical significance in cardiovascular medicine. The proposed new AC staging system integrates multiple parameters including circulating biomarkers such as NT-proBNP and troponin, atrial geometry measurements obtained through advanced imaging techniques, and electrophysiological changes detected by electrocardiography and electrophysiological studies to provide comprehensive disease characterization. Recent multicenter studies have established a strong independent connection between AC and stroke risk, regardless of the pre­sence of atrial fibrillation, fundamentally challenging traditional risk stratification approaches and suggesting the need for revised therapeutic guidelines. Current diagnostic methods encompass advanced cardiac imaging techniques including echocardiography and cardiac magnetic resonance imaging, comprehensive biomarker assessment, and sophisticated electrophysiolo­gical testing protocols. The condition shows significant association with heart failure development and progression, highlighting its importance in preventive cardiology strategies. Atrial cardiomyopathy represents a paradigm shift in modern cardiovascular medicine with significant potential for improving the prevention and treatment of atrial fibrillation, stroke, and heart failure through targeted interventions. However, this emerging field requires extensive further research to validate the proposed staging system, establish standardized diagnostic criteria, develop evidence-based therapeutic approaches targeting atrial substrate modification, and determine optimal patient management strategies.