Abstract

GALLEGO MUNOZ, Catalina; SALDARRIAGA, Clara Inés  and  DIEZ MARTINEZ, Javier. Myocardial fibrosis: towards a new approach. Rev. Colomb. Cardiol. [online]. 2019, vol.26, n.3, pp.142-151. ISSN 0120-5633.  https://doi.org/10.1016/j.rccar.2018.09.006.

Myocardial fibrosis, which is present in those diseases that have a pressure overload, such as aortic stenosis or hypertensive heart disease, are a diffuse form of progressive and reactive-type fibrosis. This has a large impact on cardiac function, manifested as a diastolic and/or systolic dysfunction, development of arrhythmias or myocardial ischaemia. It is believed that it precedes the rest of the left ventricular structural changes in this type of disease, and is characterised by the presence of an extracellular matrix rich in collagen type I and III fibres with a high level of cross-linking. It is a prognostic marker and there is a direct correlation between the level of myocardial fibrosis and outcomes, such as heart failure and mortality.

The diagnostic approach of myocardial fibrosis in this group of patients could be made using chemical or imaging biomarkers. The first ones are still study material in order to achieve a better precision in their results, and cardiac nuclear resonance with T1 mapping technique is the most attractive imaging technique.

The treatment of myocardial fibrosis in diseases with pressure overload, is given by the standard management of heart failure, in which case the ACEI/ARAII family of hypertensive drugs have been associated at a higher level with a change in the grade of myocardial fibrosis. However, more studies are needed in order to define the use of new therapeutic targets that may complement the treatment and improve the outcomes in this group of patients.

Keywords : Endomyocardial fibrosis; Hypertension; Aortic stenosis.

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