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Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance

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Abstract

Myocardial remodelling involves not only the myocytes, but also non-myocyte cells and the extracellular matrix, which constitutes around 6 % of the normal heart and includes fluid, collagen and glycoproteins. In non-ischaemic dilated cardiomyopathy (DCM), the cardiac interstitium increases as a result of diffuse interstitial (microscopic) fibrosis, post-necrotic replacement (macroscopic) fibrosis or myocardial oedema. The activation of the renin–angiotensin–aldosterone system is a major determinant of fibroblasts activation and collagen deposition, with the transforming growth factor β as the downstream signal mediator. Endomyocardial biopsy still represents the current reference method for interstitial and replacement myocardial fibrosis assessment, but cardiovascular magnetic resonance (CMR) allows in vivo detection of macroscopic fibrosis with post-contrast late enhancement imaging. Moreover, recent pre- and post-contrast T1 mapping techniques provide a quantitative estimation of myocardial interstitial remodelling, with potential diagnostic and prognostic clinical utility. Here, we review the pathophysiological mechanisms of myocardial interstitial remodelling in DCM, its non-invasive characterization with biomarkers and with CMR, as well as the most recent studies about their clinical utility.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

DCM:

Dilated cardiomyopathy

ECV:

Extracellular volume

LGE:

Late gadolinium enhancement

LV:

Left ventricular

MMP:

Matrix metalloproteinase

MOLLI:

Modified look-locker inversion recovery

NT-proBNP:

N-terminal fragment of the pro-brain natriuretic peptide

ShMOLLI:

Shortened modified look-locker inversion recovery

TGF-β:

Transforming growth factor beta

TNF-α:

Tumour necrosis factor alpha

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Authors and Affiliations

  1. Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy

    Andrea Barison, Chrysanthos Grigoratos, Giancarlo Todiere & Giovanni Donato Aquaro

  2. Scuola Superiore Sant’Anna, Pisa, Italy

    Andrea Barison & Giancarlo Todiere

  3. Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy

    Chrysanthos Grigoratos

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  1. Andrea Barison
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  2. Chrysanthos Grigoratos
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Correspondence to Andrea Barison.

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Drs. Barison A., Grigoratos C., Todiere G., Aquaro G. D. have no conflicts of interest or financial ties to disclose.

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Barison, A., Grigoratos, C., Todiere, G. et al. Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance. Heart Fail Rev 20, 731–749 (2015). https://doi.org/10.1007/s10741-015-9509-4

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