Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic target
IntroductionHypertrophic cardiomyopathy (HCM) is a common genetic cardiac disease marked by abnormal ventricular hypertrophy. Recent studies have highlighted that left atrial (LA) remodelling—including dilation, fibrosis, and functional impairment—plays a key role in disease progression and prognosi...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-07-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1620313/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850085119676645376 |
|---|---|
| author | Chiara Piazzai Alessio Petrone Andrea Stefanini Flavio D’Ascenzi Iacopo Olivotto Iacopo Olivotto Matteo Cameli |
| author_facet | Chiara Piazzai Alessio Petrone Andrea Stefanini Flavio D’Ascenzi Iacopo Olivotto Iacopo Olivotto Matteo Cameli |
| author_sort | Chiara Piazzai |
| collection | DOAJ |
| description | IntroductionHypertrophic cardiomyopathy (HCM) is a common genetic cardiac disease marked by abnormal ventricular hypertrophy. Recent studies have highlighted that left atrial (LA) remodelling—including dilation, fibrosis, and functional impairment—plays a key role in disease progression and prognosis, notably increasing the risk of atrial fibrillation (AF) and stroke.Material and methodsThis review article systematically examines published clinical, imaging, and interventional studies. The analysis focuses on identifying the determinants of atrial myopathy, its relationship with diastolic dysfunction and left ventricular outflow tract obstruction (LVOTO), and the effects of therapeutic interventions such as septal reduction therapy and cardiac myosin inhibitors.ResultsThe findings reveal that LA remodelling in HCM is characterized by increased LA volume, reduced atrial strain, and prolonged conduction times—all of which are strongly linked to the onset and recurrence of AF. Moreover, interventions that reduce LVOTO (e.g., surgical myectomy) have been shown to induce LA reverse remodelling and improve diastolic parameters. Emerging therapies, like cardiac myosin inhibitors, also improve LV function but present complex effects on atrial performance, with some evidence suggesting a reduction in atrial strain that warrants further investigation.ConclusionAtrial remodelling is a significant marker of disease severity in HCM and an important independent predictor of adverse outcomes, including AF and cardioembolic events. Early detection through comprehensive multimodal imaging and timely therapeutic intervention can potentially mitigate these risks, making atrial myopathy both a critical prognostic factor and a promising therapeutic target. |
| format | Article |
| id | doaj-art-06ca110df54e4345a9a322169f2e9812 |
| institution | DOAJ |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-06ca110df54e4345a9a322169f2e98122025-08-20T02:43:49ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-07-011210.3389/fcvm.2025.16203131620313Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic targetChiara Piazzai0Alessio Petrone1Andrea Stefanini2Flavio D’Ascenzi3Iacopo Olivotto4Iacopo Olivotto5Matteo Cameli6Unit Cardiomyopathies, Department of Clinical and Experimental Medicine, University of Florence, Florence, ItalyUnit Cardiomyopathies, Department of Clinical and Experimental Medicine, University of Florence, Florence, ItalyDepartment of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, ItalyDepartment of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, ItalyUnit Cardiomyopathies, Department of Clinical and Experimental Medicine, University of Florence, Florence, ItalyCardiology Unit, Meyer University Children Hospital, Florence, ItalyDepartment of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, ItalyIntroductionHypertrophic cardiomyopathy (HCM) is a common genetic cardiac disease marked by abnormal ventricular hypertrophy. Recent studies have highlighted that left atrial (LA) remodelling—including dilation, fibrosis, and functional impairment—plays a key role in disease progression and prognosis, notably increasing the risk of atrial fibrillation (AF) and stroke.Material and methodsThis review article systematically examines published clinical, imaging, and interventional studies. The analysis focuses on identifying the determinants of atrial myopathy, its relationship with diastolic dysfunction and left ventricular outflow tract obstruction (LVOTO), and the effects of therapeutic interventions such as septal reduction therapy and cardiac myosin inhibitors.ResultsThe findings reveal that LA remodelling in HCM is characterized by increased LA volume, reduced atrial strain, and prolonged conduction times—all of which are strongly linked to the onset and recurrence of AF. Moreover, interventions that reduce LVOTO (e.g., surgical myectomy) have been shown to induce LA reverse remodelling and improve diastolic parameters. Emerging therapies, like cardiac myosin inhibitors, also improve LV function but present complex effects on atrial performance, with some evidence suggesting a reduction in atrial strain that warrants further investigation.ConclusionAtrial remodelling is a significant marker of disease severity in HCM and an important independent predictor of adverse outcomes, including AF and cardioembolic events. Early detection through comprehensive multimodal imaging and timely therapeutic intervention can potentially mitigate these risks, making atrial myopathy both a critical prognostic factor and a promising therapeutic target.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1620313/fullhypertrophic cardiomyopathyatrial myopathymultimodal imagingatrial fibrillationseptal reduction therapycardiac myosin inhibitors |
| spellingShingle | Chiara Piazzai Alessio Petrone Andrea Stefanini Flavio D’Ascenzi Iacopo Olivotto Iacopo Olivotto Matteo Cameli Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic target Frontiers in Cardiovascular Medicine hypertrophic cardiomyopathy atrial myopathy multimodal imaging atrial fibrillation septal reduction therapy cardiac myosin inhibitors |
| title | Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic target |
| title_full | Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic target |
| title_fullStr | Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic target |
| title_full_unstemmed | Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic target |
| title_short | Atrial remodelling and dysfunction in hypertrophic cardiomyopathy: prognostic role and therapeutic target |
| title_sort | atrial remodelling and dysfunction in hypertrophic cardiomyopathy prognostic role and therapeutic target |
| topic | hypertrophic cardiomyopathy atrial myopathy multimodal imaging atrial fibrillation septal reduction therapy cardiac myosin inhibitors |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1620313/full |
| work_keys_str_mv | AT chiarapiazzai atrialremodellinganddysfunctioninhypertrophiccardiomyopathyprognosticroleandtherapeutictarget AT alessiopetrone atrialremodellinganddysfunctioninhypertrophiccardiomyopathyprognosticroleandtherapeutictarget AT andreastefanini atrialremodellinganddysfunctioninhypertrophiccardiomyopathyprognosticroleandtherapeutictarget AT flaviodascenzi atrialremodellinganddysfunctioninhypertrophiccardiomyopathyprognosticroleandtherapeutictarget AT iacopoolivotto atrialremodellinganddysfunctioninhypertrophiccardiomyopathyprognosticroleandtherapeutictarget AT iacopoolivotto atrialremodellinganddysfunctioninhypertrophiccardiomyopathyprognosticroleandtherapeutictarget AT matteocameli atrialremodellinganddysfunctioninhypertrophiccardiomyopathyprognosticroleandtherapeutictarget |