Heart Failure, Female Sex, and Atrial Fibrillation Are the Main Drivers of Human Atrial Cardiomyopathy: Results From the CATCH ME Consortium

作者：Joris Winters, Aaron Isaacs, Stef Zeemering, Michał Kawczyński, Bart Maesen, Jos G. Maessen, Elham Bidar, Bastiaan J. Boukens, B J M Hermans, Arne van Hunnik, Barbara Casadei, Larissa Fabritz, Winnie Chua, Laura C. Sommerfeld, Eduard Guasch, Lluı́s Mont, Montserrat Batlle, Stéphane Hatem, Paulus Kirchhof, Reza Wakili, Mortiz Sinner, Monica Stoll, Andreas Goette, Sander Verheule, Ulrich Schotten · 发表于：Journal of the American Heart Association · 年份：2023 · 被引用次数：31 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiovascular Function and Risk Factors、Cardiovascular Effects of Exercise

Background Atrial cardiomyopathy (atCM) is an emerging prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy, and capillary density are hallmarks of atCM. The contribution of etiological factors and atrial fibrillation (AF) to the development of differential atCM phenotypes has not been quantified. This study aimed to evaluate the association between histological features of atCM and the clinical phenotype. Methods and Results We examined left atrial (LA, n=95) and right atrial (RA, n=76) appendages from a European cohort of patients undergoing cardiac surgery. Quantification of histological atCM features was performed following wheat germ agglutinin/CD31/vimentin staining. The contributions of AF, heart failure, sex, and age to histological characteristics were determined with multiple linear regression models. Persistent AF was associated with increased endomysial fibrosis (LA: +1.13±0.47 μm, P =0.038; RA: +0.94±0.38 μm, P =0.041), whereas total extracellular matrix content was not. Men had larger cardiomyocytes (LA: +1.92±0.72 μm, P <0.001), while women had more endomysial fibrosis (LA: +0.99±0.56 μm, P =0.003). Patients with heart failure showed more endomysial fibrosis (LA: +1.85±0.48 μm, P <0.001) and extracellular matrix content (LA: +3.07±1.29%, P =0.016), and a higher capillary density (LA: +0.13±0.06, P =0.007) and size (LA: +0.46±0.22 μm, P =0.044). Fuzzy k‐means clustering of histological features identified 2 subtypes of atCM...