REVIEW article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1620313
This article is part of the Research TopicExploring Hypertrophic Cardiomyopathy and Cardiac AmyloidosisView all articles
Atrial Remodelling and Dysfunction in Hypertrophic Cardiomyopathy: Prognostic Role and Therapeutic Target
Provisionally accepted
- 1Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- 2Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- 3Cardiology Unit, Meyer University Children Hospital, Florence, Italy
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Introduction: Hypertrophic 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 & Methods: This 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.Results: The 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.Conclusion: Atrial 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.
Keywords: Hypertrophic Cardiomyopathy, Atrial myopathy, Multimodal Imaging, Atrial Fibrillation, septal reduction therapy, cardiac myosin inhibitors
Received: 29 Apr 2025; Accepted: 25 Jun 2025.
Copyright: © 2025 Piazzai, Petrone, Stefanini, D'Ascenzi, Olivotto and Cameli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alessio Petrone, Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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