Towards understanding atrial cardiomyopathy in atrial fibrillation: the role of comorbidities and its association with outcome

    Research output: ThesisThesis fully internal (DIV)

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    Atrial fibrillation (AF) is a condition characterized by irregular heartbeat, affecting millions of people worldwide. Although AF itself is not directly fatal, it is linked to various risk factors and other health issues like poor quality of life, stroke, heart failure, and worse cardiovascular outcomes. AF is considered a progressive disease, meaning it worsens over time, particularly as more risk factors and comorbidities accumulate. The progression of AF involves changes in the structure and function of the atria (the upper chambers of the heart), known as atrial cardiomyopathy (ACM). ACM encompasses a range of changes in the atria that can contribute to clinical manifestations of AF.
    The general aim of this thesis was to provide insights on how risk factors, comorbidities and sex differences are associated to AF and its progression. This association was investigated by exploring underlying mechanisms using clinical, echocardiographic and blood biomarkers. In addition, this thesis aimed to explore the role of ACM in AF and its progression.
    ACM can be challenging to measure directly, as it often requires invasive procedures to examine atrial tissue. Instead, alternative non-invasive techniques can provide insights into ACM. These methods include imaging techniques, like echocardiography, and blood biomarkers associated with ACM.
    The results of this thesis suggest that ACM starts early in the presence of AF and comorbidities, and in patients with multiple comorbidities, ACM is already well established. These results may indicate that controlling comorbidities and managing AF early may be crucial in stopping or delaying ACM. Additionally, results from this thesis found differences between men and women with AF. Biomarker levels suggest that the underlying pathophysiological mechanisms of AF may vary between men and women, with more inflammatory responses in women and more prominent vascular remodeling in men. Understanding these differences could help tailor interventions for AF based on sex-specific considerations.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    • van Gelder, Isabelle, Supervisor
    • Rienstra, Michiel, Supervisor
    Award date17-Apr-2024
    Place of Publication[Groningen]
    Publication statusPublished - 2024


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