Myocardial Fibrosis in Heart Failure: Anti-Fibrotic Therapies and the Role of Cardiovascular Magnetic Resonance in Drug Trials

• Published in: Cardiology and Therapy Vol. 9; no. 2; pp. 363 - 376
• Main Authors: Webber, Matthew, Jackson, Stephen P., Moon, James C., Captur, Gabriella
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.12.2020; Springer; Adis, Springer Healthcare
• Subjects: Advances in Heart Failure; Anti-fibrotic therapies; Cardiac magnetic resonance imaging; Cardiology; Care and treatment; Clinical trials; Collagen; Complications and side effects; Diagnosis; Drug therapy; Drugs; Extracellular volume; Fibrosis; Heart failure; Hydrochlorothiazide; Internal Medicine; Medicine; Medicine & Public Health; Myocardial fibrosis; Review; Risk factors; T 1 mapping; United Kingdom; Anti-fibrotic therapies; Myocardial fibrosis; mapping; Extracellular volume; Cardiac magnetic resonance imaging; T1 mapping
• ISSN: 2193-8261; 2193-6544
• DOI: 10.1007/s40119-020-00199-y

All heart muscle diseases that cause chronic heart failure finally converge into one dreaded pathological process that is myocardial fibrosis. Myocardial fibrosis predicts major adverse cardiovascular events and death, yet we are still missing the targeted therapies capable of halting and/or reversing its progression. Fundamentally it is a problem of disproportionate extracellular collagen accumulation that is part of normal myocardial ageing and accentuated in certain disease states. In this article we discuss the role of cardiovascular magnetic resonance (CMR) imaging biomarkers to track fibrosis and collate results from the most promising animal and human trials of anti-fibrotic therapies to date. We underscore the ever-growing role of CMR in determining the efficacy of such drugs and encourage future trialists to turn to CMR when designing their surrogate study endpoints.