Slide 1: Recognizing Atrial Cardiomyopathy
Recognizing Atrial Click to edit Section Title Cardiomyopathy Click to edit subtitle title A Progressively Damaging Environment [ 1] Confidential – For Internal Education Use Only – Not for Distribution
Slide 2: Recognizing Atrial Cardiomyopathy: A Progressively Damaging Environment
Recognizing Atrial Cardiomyopathy: A Progressively Damaging Environment ACT against Afib AtriCure
Slide 3: Structure, Rhythm, and Function All Play a Role in Cardiac Output
Structure, Rhythm, and Function All Play a Role in Cardiac Output
Slide 4: Why Is Atrial Cardiomyopathy Important?
Why Is Atrial Cardiomyopathy Important? • Atrial cardiomyopathies are thought to precede the onset of atrial fibrillation (Afib), even in patients without gross structural or functional myocardial dysfunction.1 • Most Afib patients have an established form of an atrial cardiomyopathy (ACM) which app
Slide 5: What Is Atrial Cardiomyopathy?
What Is Atrial Cardiomyopathy? • ACM is any complex of structural, architectural, contractile or electrophysiological changes affecting the atria with the potential to produce clinically-relevant manifestations.3 • In short, ACM is atrial damage, which alters cellular structure or causes cell death.
Slide 6: Main Etiopathogenic Mechanisms Involved in Atrial Cardiomyopathy
Main Etiopathogenic Mechanisms Involved in Atrial Cardiomyopathy
Slide 7: What Causes Atrial Cardiomyopathy? The Environment: Cellular and Systemic
What Causes Atrial Cardiomyopathy? The Environment: Cellular and Systemic
Slide 8: The Three S's: Stress
The Three S’s Stress • Proper cell function depends on a delicate balance between antioxidants, reactive oxygen species (ROS) and antioxidant defense mechanisms. • Oxidative stress occurs when that balance is persistently impacted, resulting in excessive ROS that damage components of cells, includin
Slide 9: The Three S's: Stress (cont.)
The Three S’s Stress (cont.) • These risk factors generate the increased ROS that leads to the cellular changes resulting in inflammation and fibrosis.2 • Inflammation is an adaptive response that can be beneficial but becomes destructive when dysregulated. • Recent studies have shown that inflammat
Slide 10: The Three S's: Stretch
The Three S’s Stretch • Anything that creates pressure or volume overload of the atria causes elongation of the cardiomyocytes, which results in increased atrial stretch.6 As atrial size increases, so does the risk of stroke and persistent reentry circuits. • Changes that promote Afib and atrial rem
Slide 11: The Three S's: Scar
The Three S’s Scar • Another hallmark of structural remodeling and an important substrate of Afib is fibrosis, which is the formation of excessive extracellular matrix consisting of mainly fibroblasts and elastic and collagen fibers.6 • Fibrosis and myocyte injury can result in scar tissue in the at
Slide 12: Atrial Cardiomyopathy: How To Recognize It
Atrial Cardiomyopathy: How To Recognize It • There are three important mechanisms to detect the development of ACM: • Fibrosis • Electrical dysfunction • Mechanical dysfunction • Histological examination is only an option for few patients due to the invasive nature of a left atrial biopsy. 11 • Mark
Slide 13: Atrial Cardiomyopathy: How To Recognize It
Atrial Cardiomyopathy: How To Recognize It
Slide 14: CHA2DS2-VASc
CHA2DS2-VASc • The CHA2DS2-VASc score is a point-based system used to stratify the risk of stroke in Afib patients and make recommendations for reducing risk.13 • A higher number indicates a patient is more statistically likely to have a stroke • A higher score also predicts mortality in cardiac pat
Slide 15: CHA2DS2-VASc: Clinical Predictors of Stroke Risk Associated with Afib
CHA2DS2-VASc (15) Clinical Predictors of Stroke Risk Associated with Afib Figure3 Clinical Predictors of Stroke Risk Incorporated in the CHADS» and CHA2DS2-VASc Schemes All-Cause Atrial Cardiomyopathy This observation supports the idea that atrial cardiomyopathy may be a direct contributor to stroke
Slide 16: Left Atrial Enlargement (LAE)
Left Atrial Enlargement (LAE) Left atrial size and function have been increasing in importance to determining prognosis and risk stratification of patients. In particular, LAE can result from an intrinsic atrial abnormality, altered workload, or compensation. Atrial structural remodeling is characte
Slide 17: NT-proBNP
NT-proBNP The neurohormone B-type natriuretic peptide (BNP) is a regulator of cardiovascular function17 and a biomarker used to measure cardiac function in the detection of HF.18 It’s also a well-known indicator of congestive HF due to volume overload and myocardial damage and has shown a strong cor
Slide 18: Bringing It All Together
Bringing It All Together: Death, longevity, and the environment for Afib In short, ACM is a sick atrium, developing and exhibiting all the characteristics of Afib – even before Afib exists. In addition to creating the environment that can lead to the development of Afib, the markers for ACM are inde
Slide 19: To find out more, visit ACTagainstAfib.com
To find out more, visit ACTagainstAfib.com [ 19 ]
Slide 20: References
References Figure 1 adopted from Dmour, B.A. et al. (2021). Latest insights into mechanisms behind atrial cardiomyopathy: It is not always about ventricular function. Diagnostics, 11(3):449. Figure 2 adopted from Kreimer, F. & Gotzmann, M. (2022). Left Atrial Cardiomyopathy – A Challenging Diagnosis
Slide 21: References
References 10 Jorge, A.J.L., Martins, W.D.A., Mesquita, E.T., & Carvalho, M.R.M.D. (2022). Left Atrial Cardiomyopathy as a Generator of Heart Failure with Preserved Ejection Fraction. ABC Heart Fail Cardiomyop, 2(3):259-67. 11 Kreimer, F. & Gotzmann, M. (2022). Left Atrial Cardiomyopathy–A Challengi