Left Atrial Myocardium in Arterial Hypertension

Arterial hypertension affects approximate to 1 billion people worldwide. It is associated with increased morbidity and mortality and responsible for millions of deaths each year. Hypertension mediates damage of target organs including the heart. In addition to eliciting left ventricular hypertrophy, dysfunction and heart failure, hypertension also causes left atrial remodeling that may culminate in atrial contractile dysfunction and atrial fibrillation. Here, we will summarize data on the various aspects of left atrial remodeling in (essential) hypertension gathered from studies on patients with hypertension and from spontaneously hypertensive rats, an animal model that closely mimics cardiac remodeling in human hypertension. Analyzing the timeline of remodeling processes, i.e., distinguishing between alterations occurring in prehypertension, in early hypertension and during advanced hypertensive heart disease, we will derive the potential mechanisms underlying left atrial remodeling in (essential) hypertension. Finally, we will discuss the consequences of these remodeling processes for atrial and ventricular function. The data imply that left atrial remodeling is multifactorial, starts early in hypertension and is an important contributor to the progression of hypertensive heart disease, including the development of atrial fibrillation and heart failure.

Automated summary

Arterial hypertension affects approximately 1 billion people worldwide, resulting in increased morbidity and mortality. In addition to cardiac damage such as left ventricular hypertrophy, dysfunction, and heart failure, hypertension also causes left atrial remodeling, potentially leading to atrial contractile dysfunction and atrial fibrillation. This review examines the various aspects of left atrial remodeling in hypertension, identifying potential mechanisms and discussing its consequences for atrial and ventricular function.