Diagnosis of atrial cardiomyopathy: from the electrocardiogram to the new opportunities with multimodality imaging.

Atrial cardiomyopathy (AC) has been defined by the European Heart Rhythm Association as "Any complex of structural, architectural, contractile, or electrophysiologic changes in the atria with the potential to produce clinically relevant manifestations".1 The left atrium (LA) plays a key role in maintaining normal cardiac function; in fact atrial dysfunction has emerged as an essential determinant of outcomes in different clinical scenarios, such as valvular diseases, heart failure (HF), coronary artery disease (CAD) and atrial fibrillation (AF). A comprehensive evaluation, both anatomical and functional, is routinely performed in cardiac imaging laboratories. Recent advances in imaging techniques offer opportunities for evaluation of LA function, fundamental in clinical practice for early cardiovascular (CV) risk estimation, choice of therapeutic intervention and follow up. In this review we explore the concept of AC, its diagnosis through a multimodal approach, ranging from the historical electrocardiogram to the latest CV imaging techniques and its clinical implications.