Is left atrium the best kept secret of the heart? Left atrial dilatation and cardiovascular outcomes

The left atrium (LA) plays an important role in cardiovascular homeostasis through the modulation of cardiac filling and output, as well as the regulation of circulatory volume and tone. LA remodelling is characterised by dynamic alterations in atrial structure, function and electrophysiology. Most frequently, it occurs in association with ageing, hypertension, ischaemia, metabolic and pulmonary disorders (central illustration, figure 1). LA dilatation, the hallmark of atrial remodelling, has been increasingly recognised as a prognostic biomarker of thromboembolic and cardiovascular events, in particular in patients with atrial fibrillation (AF). However, cardiovascular risk attributable to atrial dilatation also appears to be increased in individuals without AF and is incompletely explained by the associated comorbidities and risk factors. The clarification of this issue was attempted by putting forward the concept of atrial cardiomyopathy, as a primary form of atrial abnormality, in which atrial fibrosis, hypercoagulability, contractile and endothelial dysfunction may…

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