Evaluating the Atrial Myopathy Underlying Atrial Fibrillation: Identifying the Arrhythmogenic and Thrombogenic Substrate.
Evaluating the Atrial Myopathy Underlying Atrial Fibrillation: Identifying the Arrhythmogenic and Thrombogenic Substrate.
复制标题
评估心房基础纤颤的心房肌病：识别心律失常和血栓形成底物。
DOI：
10.1161/circulationaha.115.016795
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发表时间：
2015-07-28
期刊：
影响因子：
37.8
通讯作者：
Shah SJ
中科院分区：
文献类型：
--
作者：
Goldberger JJ;Arora R;Green D;Greenland P;Lee DC;Lloyd-Jones DM;Markl M;Ng J;Shah SJ
心房疾病或肌病是心房颤动 (AF) 的基础，也是心房血栓形成和随后中风的潜在因素。目前 AF 患者的诊断方法侧重于确定临床预测因素，通过超声心动图评估左心房大小，作为专门评估心房的唯一措施。尽管 AF 潜在的心房基质可能在 AF 发病前数年就已形成，但目前尚无评估来识别临床前心房肌病。心房纤维化是心房基质的一个组成部分，最近基于较新的 MRI 技术引起了人们的关注，该技术已应用于可视化人类心房纤维化，并对治疗成功与否产生预后影响。先进的心电图信号处理、超声心动图技术以及纤维化和血流的 MRI 成像提供了评估 AF 潜在的心房肌病的最新方法。虽然血栓栓塞风险目前是通过临床评分来定义的，但其预测价值一般。通过成像和与血栓形成相关的生物标志物评估瘀血可能提供增强的方法来评估房颤患者中风的风险。更好地描述心房肌病（房颤和血栓栓塞并发症的根源）可能会改善治疗结果。此外，更好地描述房颤发生的心房基质的病理生理机制，特别是在其早期阶段，可以帮助识别血液和影像生物标志物，这些标志物可用于评估新发房颤的风险，并提出可用于预防的具体途径。
Atrial disease or myopathy forms the substrate for atrial fibrillation (AF) and underlies the potential for atrial thrombus formation and subsequent stroke. Current diagnostic approaches in patients with AF focus on identifying clinical predictors with evaluation of left atrial size by echocardiography serving as the sole measure specifically evaluating the atrium. Although the atrial substrate underlying AF is likely developing for years prior to the onset of AF, there is no current evaluation to identify the pre-clinical atrial myopathy. Atrial fibrosis is one component of the atrial substrate that has garnered recent attention based on newer MRI techniques that have been applied to visualize atrial fibrosis in humans with prognostic implications regarding success of treatment. Advanced ECG signal processing, echocardiographic techniques, and MRI imaging of fibrosis and flow provide up-to-date approaches to evaluate the atrial myopathy underlying AF. While thromboembolic risk is currently defined by clinical scores, their predictive value is mediocre. Evaluation of stasis via imaging and biomarkers associated with thrombogenesis may provide enhanced approaches to assess risk for stroke in patients with AF. Better delineation of the atrial myopathy that serves as the substrate for AF and thromboembolic complications might improve treatment outcomes. Furthermore, better delineation of the pathophysiologic mechanisms underlying the development of the atrial substrate for AF, particularly in its earlier stages, could help identify blood and imaging biomarkers that could be useful to assess risk for developing new onset AF and suggest specific pathways that could be targeted for prevention.