Atrial cardiomyopathy: current clinical perspectives and future insights

Atrial cardiomyopathy (ACM) is an underrecognized cardiac entity marked by structural, contractile, or electrophysiological changes in the atria, yet it lacks established clinical diagnostic criteria and management guidelines. These alterations - driven by molecular, mechanical, and genetic factors - lead to atrial remodeling and contribute to arrhythmogenesis, thromboembolic complications, and the progression of heart failure. Despite recent advances in imaging, biomarkers, and histopathological classifications, the pathophysiology of ACM remains complex and multifactorial, involving processes such as inflammation, oxidative stress, and genetic predisposition. This review synthesizes current knowledge on ACM, including its classification, pathophysiologic mechanisms, and clinical relevance in atrial fibrillation, ischemic stroke, and heart failure with preserved ejection fraction (HFpEF). We also explore emerging diagnostic tools and biomarkers that may aid in risk stratification and therapeutic decision-making. Ultimately, we aim to underscore the clinical significance of ACM and advocate for the development of standardized diagnostic frameworks and personalized treatment strategies to improve patient outcomes.