Atrial disease and heart failure: the common soil hypothesis proposed by the Heart Failure Association of the European Society of Cardiology

A proposed conceptual framework for understanding atrial disease. Subclinical atrial disease develops under the effect of stressors such as aging, cardio-metabolic risk factors and diseases, and genetic predisposition that activate pathogenic mechanisms, such as inflammation, endothelial and microvascular dysfunction, fibrosis, hypercoagulability and atrial stretch that in turn affect the atrial myocardium. Subclinical atrial disease is characterized by structural, electrical and functional changes, also termed atrial remodelling, that progress to overt clinical disease, manifesting as atrial fibrillation, heart failure and further to thromboembolism. The potential detection of subclinical atrial disease with imaging, biomarkers and other modalities offers a window opportunity for interventions that would prevent deterioration to clinical disease and could potentially allow reversal of subclinical disease. CMR, cardiac magnetic resonance; CT, computed tomography; ECG, electrocardiogram; RF, risk factors. A proposed conceptual framework for understanding atrial disease. Subclinical atrial disease develops under the effect of stressors such as aging, cardio-metabolic risk factors and diseases, and genetic predisposition that activate pathogenic mechanisms, such as inflammation, endothelial and microvascular dysfunction, fibrosis, hypercoagulability and atrial stretch that in turn affect the atrial myocardium. Subclinical atrial disease is characterized by structural, electrical and functional changes, also termed atrial remodelling, that progress to overt clinical disease, manifesting as atrial fibrillation, heart failure and further to thromboembolism. The potential detection of subclinical atrial disease with imaging, biomarkers and other modalities offers a window opportunity for interventions that would prevent deterioration to clinical disease and could potentially allow reversal of subclinical disease. CMR, cardiac magnetic resonance; CT, computed tomography; ECG, electrocardiogram; RF, risk factors.