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Myocardial fibrosis and cardiac dysfunction: the added value of imaging.

Heart Failure (HF)


Myocardial fibrosis represents one of the main determinants of heart failure, in particular in the presence of preserved ejection fraction. This session highlighted this issue, pointing out the role of cardiac imaging for the diagnosis of myocardial fibrosis.
Elif Saafe (Turkey) described the triggering and promoting factors of myocardial fibrosis, namely mechanical trauma, infections, radiation, atherosclerosis, and thrombosis. Cytokines play an important role in modulating the development of myocardial fibrosis. Angiotensin II and aldosterone are also deeply involved in this process. Myocardial fibrosis has to be divided in two different entities, i.e. reactive fibrosis (after myocyte loss) and reparative fibrosis. They can develop after myocardial infarction, but also in hypertensive heart disease and in diabetic cardiomyopathy.
In the second lecture, Prof Thomas Marwick described the role of cardiac imaging in detecting the presence of myocardial fibrosis. Functional techniques, such as pulsed Tissue Doppler (E’ and S’ velocities), Tissue Velocity Imaging (TVI), strain and cardiac MRI have to be differentiated by structural techniques such as late gadolinium enhancement (LGE) and integrated backscatter (IBS). Also, nuclear imaging (PET, SPECT-banded integrin labeled fibroblasts) can provide quantitative information on myocardial fibrosis.
The prognostic impact of myocardial fibrosis, summarized by Prof. Kosmala, was clearly demonstrated in non-ischemic and ischemic dilated cardiomyopathy, in hypertrophic cardiomyopathy, in aortic valve stenosis, as well as in infiltrative diseases (cardiac amyloidosis, sarcoidosis, Fabry’s disease).
The regression of myocardial fibrosis (Dr Frank Weidemann) cannot be achieved by aortic valve replacement, either surgical or TAVI. However, interstitial fibrosis regression has been demonstrated under enzyme replacement therapy in storage diseases, by aldosterone antagonists and by enalapril (uremic cardiomyopathy).This still has to be confirmed, but clearly it is important to perform more studies about myocardial fibrosis.

References


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Myocardial fibrosis and cardiac dysfunction: the added value of imaging.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.