Detection of myocardial fibrosis: Where we stand

Abstract

Myocardial fibrosis, resulting from the disturbance of extracellular matrix homeostasis in response to different insults, is a common and important pathological remodeling process that is associated with adverse clinical outcomes, including arrhythmia, heart failure, or even sudden cardiac death. Over the past decades, multiple non-invasive detection methods have been developed. Laboratory biomarkers can aid in both detection and risk stratification by reflecting cellular and even molecular changes in fibrotic processes, yet more evidence that validates their detection accuracy is still warranted. Different non-invasive imaging techniques have been demonstrated to not only detect myocardial fibrosis but also provide information on prognosis and management. Cardiovascular magnetic resonance (CMR) is considered as the gold standard imaging technique to non-invasively identify and quantify myocardial fibrosis with its natural ability for tissue characterization. This review summarizes the current understanding of the non-invasive detection methods of myocardial fibrosis, with the focus on different techniques and clinical applications of CMR.

Adipocyte Enhancer Binding Protein 1 (AEBP1) Inhibition as a Potential Anti-Fibrotic Therapy in Heart Failure.

“…1a-b). Increase in wellknown pro-fibrotic transcription factors (including RUNX1 25 and MEOX1 26 ) and pro-fibrotic genes (including ACTA2 27 , TAGLN 28 , SMOC2 29 and COL1A1) were also observed in the myocardial tissue from these patients (Supplemental Fig. 1a).…”

Significant Association between Subclinical Left Cardiac Dysfunction and Liver Stiffness in Metabolic Syndrome Patients with Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease

“…Although the LA and LV diameters, volumes, and ejection percentages did not differ substantially between MetS participants with and without DM, the 2D-STE revealed LA and LV deformation features that were significantly worse in the presence of DM, indicating subclinical dysfunction ( p < 0.04). According to previous research, the pattern of myocardial deformation is highly related to the severity of myocardial fibrosis determined by cardiac MRI or histopathologic samples [ 37 ].…”

Myocardial Interstitial Fibrosis in Hypertensive Heart Disease: From Mechanisms to Clinical Management

“…69 Some of them may be useful to characterize myocardial tissue composition (eg, echocardiographic assessment of myocardial reflectivity and deformation, cardiac magnetic resonance [CMR], and computed tomography). 70 In this regard, integrated backscatter is a traditional echocardiographic approach to indirectly detect myocardial fibrosis by quantitative evaluation of ultrasound reflectivity and, more recently, strain parameters derived from the speckle tracking echocardiographic technique have been proposed that reflect the altered myocardial deformation of fibrotic tissues. 70 However, CMR based on native T1 mapping and extracellular volume (ECV) quantification is the current gold standard imaging method to evaluate MIF.…”

“…70 In this regard, integrated backscatter is a traditional echocardiographic approach to indirectly detect myocardial fibrosis by quantitative evaluation of ultrasound reflectivity and, more recently, strain parameters derived from the speckle tracking echocardiographic technique have been proposed that reflect the altered myocardial deformation of fibrotic tissues. 70 However, CMR based on native T1 mapping and extracellular volume (ECV) quantification is the current gold standard imaging method to evaluate MIF. Indeed, several studies have shown direct correlations between the ECV and the quantity of interstitial collagen deposition in cardiac patients with and without HF, 71 although none of these studies included patients with HHD.…”