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Heart Failure Reviews

, Volume 20, Issue 6, pp 731–749 | Cite as

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

  • Andrea BarisonEmail author
  • Chrysanthos Grigoratos
  • Giancarlo Todiere
  • Giovanni Donato Aquaro
Article

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.

Keywords

Dilated cardiomyopathy Fibrosis Interstitium Remodelling Magnetic resonance Late enhancement T1 mapping T2 mapping 

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

Notes

Compliance with ethical standards

Conflict of interest

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

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Andrea Barison
    • 1
    • 2
    Email author
  • Chrysanthos Grigoratos
    • 1
    • 3
  • Giancarlo Todiere
    • 1
    • 2
  • Giovanni Donato Aquaro
    • 1
  1. 1.Fondazione Toscana Gabriele MonasterioPisaItaly
  2. 2.Scuola Superiore Sant’AnnaPisaItaly
  3. 3.Cardiac, Thoracic and Vascular DepartmentUniversity of PisaPisaItaly

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