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Myocardial fibrosis leads to diastolic and or systolic dysfunction and patients can present with symptoms associated with cardiac insufficiency arrhythmias such as dyspnea, orthopnea, edema, etc.
Fibrosis can be diffuse or focal and can be as a result of different mechanisms 1:
- reactive interstitial fibrosis
- infiltrative interstitial fibrosis
- replacement fibrosis and myocardial scarring
A progressive increase of the extracellular matrix leads to diastolic and systolic dysfunction and an increase of adverse cardiovascular events 1. In end-stage heart failure, myocardial fibrosis is always present 1.
Myocardial fibrosis can occur as a result of various cardiac diseases 1 (classified by subtypes):
Reactive interstitial fibrosis
due to accelerated collagen synthesis as a result of different stimuli
Infiltrative interstitial fibrosis
progressive deposit of protein or glycosphingolipids
Due to cell damage or necrosis, an intense inflammatory response is induced, which leads to degradation of the normal interstitial matrix and generation of new matrix fragments thus an alteration of tissue composition 1,2.
- myocardial infarction, ischemic cardiomyopathy
- hypertrophic cardiomyopathy
- myocardial inflammation: myocarditis, cardiac sarcoidosis
- toxic cardiomyopathy
- chronic renal insufficiency
- T2/STIR: normal
- IRGE/PSIR: It can be seen as a late gadolinium enhancement (LGE) in focal disease. Due to the “nulling” of the myocardium in inversion-recovery sequences, it will be difficult to detect diffuse fibrosis 1.
- T2 mapping: normal T2 [ms]
- T1 mapping: increased T1 [ms] 1
- ECV: increased 1
- 1. Mewton N, Liu C, Croisille P, Bluemke D, Lima J. Assessment of Myocardial Fibrosis with Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2011;57(8):891-903. doi:10.1016/j.jacc.2010.11.013 - Pubmed
- 2. Kong P, Christia P, Frangogiannis N. The Pathogenesis of Cardiac Fibrosis. Cell Mol Life Sci. 2013;71(4):549-74. doi:10.1007/s00018-013-1349-6 - Pubmed
- 3. Treibel T, White S, Moon J. Myocardial Tissue Characterization: Histological and Pathophysiological Correlation. Curr Cardiovasc Imaging Rep. 2014;7(3):9254. doi:10.1007/s12410-013-9254-9 - Pubmed