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Methods for assessment of cardiac fibrosis. Part I

Antoniya Kisheva, Yoto Yotov, Lilyana Mircheva


Cardiac fibrosis is characterized by deposition and redis- tribution of connective tissue in the extracellular matrix. It occurs due to mechanical, chemical or electrical stimuli. Finding an accurate and easy-to-use method for assessment of myocardial fibrosis is of great clinical importance. Inva- sive and noninvasive methods are taken into account. The invasive – endomyocardial biopsy and voltage mapping, are more difficult to perform and need special technique. From the noninvasive ones - echocardiography, magnetic resonance imaging and biomarkers, are often used.


myocardial fibrosis, invasive and noninvasive methods

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Rockey D, Bell D, Hill J. Fibrosis — A Common Pathway to Organ Injury and Failure. N Engl J Med, 2015; 372:1138-49. DOI: 10.1056/NEJMra1300575

Dzeshka, MS, Lip GY, Snezhitskiy V, Shantsila

E. Cardiac fibrosis in patients with atrial fibrilla- tion. JACC, 2015; 66 (8) 943-59. doi: 10.1016/j. jacc.2015.06.1313.

Чалдъков, ГН. Клетъчна биология. Второ издание. Варна: Университетско издателство. Медицински университет – Варна, 2014.

Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA et al. EHRA/HRS/APHRS/SOLAE-

CE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016; 18 (10): 1455-1490.

Mewton N, Liu CY, Croisille P, Bluemke D, Lima JA. Assessment of Myocardial Fibrosis with Car- diac Magnetic Resonance. Am Coll Cardiol, 2011; 57(8): 891–903. doi: 10.1016/j.jacc.2010.11.013

Karamitsos TD, Francis JM, Myerson S, Selvana- yagam JB, Neubauer S. The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol, 2009; 54:1407–1424.

Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ. Delayed enhancement cardiovascular mag- netic resonance assessment of non-ischaemic car- diomyopathies. Eur Heart J, 2005; 26:1461–1474.

Weber, KT, Janicki JS, Shroff SG et al. Collagen re- modeling of the pressure-overloaded, hypertrophied nonhuman primate myocardium. Circ Res, 1988; 62, 757-765.

Weber KT, Brilla CG et Janicki JS. Myocardial fi brosis: functional signifi canceand regulatory fac- tors. Cardiovasc Res, 1993; 27 № 3, 341-348.

Shah KB, Inoue Y, Mehra MR. Amyloidosis and the heart: a comprehensive review. Arch Intern Med, 2006; 166:1805–1813.

Zarate Y, Hopkin RJ. Fabry's disease. Lancet, 2008; 372:1427–1435.

Dweck MR, Joshi S, Murigu T, Alpendurada F, Jab- bour A, Melina G, et al. Midwall fibrosis is an inde- pendent predictor of mortality in patients with aortic stenosis. J Am Coll Cardiol, 2011; 58:1271–9. doi: 10.1016/j.jacc.2011.03.064.

O’Hanlon R, Grasso A, Roughton M, Moon JC,

Clark S, Wage R et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopa- thy. J Am Coll Cardiol, 2010; 56:867–74.

Azevedo CF, Nigri M, Higuchi ML, Pomerantzeff PM, Spina GS, Sampaio RO et al. Prognostic sig- nificance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol, 2010; 56: 278-87.

Diao K, Yang Z, Xu H, Liu X, Zhang Q, Shi K et al. Histologic validation of myocardial fibrosis measured by T1 mapping: a systematic review and meta-analysis. Journal of Cardiovascular Magnetic Resonance, 2016; 18:92.

Bailin S., Hoffman C, West R, Weers N. Substrate- Based Atrial Fibrillation Ablation Guided by Volt- age Gradient Mapping: A New Approach for Atrial Fibrillation Ablation. The Journal of Innovations in Cardiac Rhythm Management, 2012; 3 1034–1041 .

Noseworthy P, Holmvang G, Kostis W, Fradley M, Barret C, Danik S et al. Visualization of Left Atrial Fibrosis by Delayed Enhancement MRI: Correla- tion to an Atypical Atrial Flutter Substrate During Endocardial Mapping and Ablation. The Journal of Innovations in Cardiac Rhythm Management, 2012; 3:1002-1005.

Gyöngyösi M, Winkler J, Ramos I, Do Q, Firat H et al. Myocardial fibrosis: biomedical research from. Eur J of Heart Failure, 2017; 19: 177-191, doi:10.1002/ejhf.696.

Jellis C, Martin J, Narula J, Marwick TH. Assess- ment of Nonischemic Myocardial Fibrosis. J Am Coll Cardiol, 2010; 56:89–97 .

Roberts WC, Siegel RJ, McManus BM. Idiopathic dilated cardiomyopathy: analysis of 152 necropsy patients. Am J Cardiol, 1987; 60:1340–1355.

Brooks A, Schinde V, Bateman AC, Gallagher PJ. Interstitial fibrosis in the dilated non-ischaemic myocardium. Heart, 2003; 89(10):1255-1256.

de Leeuw N, Ruiter DJ, Balk AH, de Jonge N, Melchers WJ, Galama JM. Histopathologic findings in explanted heart tissue from patients with end- stage idiopathic dilated cardiomyopathy. Transpl Int, 2001; 14:299–306.

Schalla S, Bekkers SC, Dennert R, van Suylen RJ, Waltenberger J, Leiner T et al. Replacement and re- active myocardial fibrosis in idiopathic dilated car- diomyopathy: comparison of magnetic resonance imaging with right ventricular biopsy. Eur J Heart Fail, 2010; 12:227–231.

Gepstein L, Hayam G, Ben-Haim SA. A novel method for nonfluoroscopic catheter-based electro- anatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation, 1997: 95:1611-22.

Rolf S, Hindricks G, Sommer P, et al. Electroana-

tomical mapping of atrial fibrillation: Review of the current techniques and advances. Journal of Atrial Fibrillation, 2014; 7(4):1140. doi:10.4022/ jafib.1140.

Knackstedt C, Schauerte P, Kirchhof P. Electro-an- atomic mapping systems in arrhythmias. Europace, 2008; 10 (suppl_3): iii28-iii34. doi: 10.1093/euro- pace/eun225.

Kim T and Ho-Joong Y. Role of Echocardiography in Atrial Fibrillation. Journal of Cardiovascular Ul- trasound, 2011; 19.2, 51–61.

Boyden PA, Tilley LP, Pham TD, Liu SK, Feno- glic JJJr, Wit AL. Effects of left atrial enlargement on atrial transmembrane potentials and structure in dogs with mitral valve fibrosis. Am J Cardiol, 1982; 49:1896-908.

Boyden PA, Tilley LP, Albala A, Liu SK,Fenoglio JJ, Wit AL. Mechanisms for atrial arrhythmias asso- ciated with cardiomyopathy: a study of feline hearts with primary myocardial disease. Circulation, 1984; 69:1036-47.

Longobardo L, Todaro MC, Zito C, Piccione MC, Di Bella G, Oreto L, et al. Role of imaging in assess- ment of atrial fibrosis in patients with atrial fibril- lation: state-of-the-art review. Eur Heart J Cardio- vasc Imaging, 2013; 15 (1):1-5.

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Arm- strong A, Ernande et al. Recommendations for Car- diac Chamber Quantification by Echocardiography in Adults An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal - Cardiovascular Imaging, 2015; 16:233 - 271. doi: 10.1016/j.echo.2014.10.003.

Olshansky B, Heller EN, Mitchell LB, Chandler M, Slater W, Green M et al. Are transthoracic echo- cardlographic parameters associated with atrial fi- brillation recurrenceor stroke? - Results from the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study. J Am Coll Cardiol, 2005; 45:2026-2033.

Rusinaru D, Tribouilloy C, Grigioni F, Avierinos JF, Suri RM, Barbieri A et al. Left Atrial Size Is a Potent Predictor of Mortality in Mitral Regurgita- tionDueto Flail Leaflets Results From a Large Inter- national Multicenter Study. Circ Cardiovasc Imag- ing, 2011; 4:473 - 481.

Lester SJ, Ryan EW, Schiller NB, Foster E. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol, 1999; 84:829–832.

Tsang TSM, Barnes ME, Gersh BJ, Takemoto Y, Rosales AG, Bailey KR et al. Prediction of risk for first age-related cardiovascular events in an elderly population: The incremental value of echocardiog- raphy. J Am Coll Cardiol, 2003; 42:1199–1205.

Vyas H, Jackson K, Chenzbraun A. Switching to volumetric left atrial measurements:impact on rou- tine echocardiographic practice. Eur J Echocar- diogr, 2011; 12.

Gottdiener JS, Kitzman DW, Aurigemma GP, Ar- nold AM, Manolio TA. Left atrial volume, geom- etry, and function in systolic and diastolic heart failure of persons > or = 65 years of age (The Car- diovascular Health Study). Am J Cardiol, 2006; 97:83–89.

Enkins C, Bricknell K, Marwick TH. Use of real- time three-dimensional echocardiography to mea- sure left atrial volume: comparison with other echo- cardiographic techniques. J Am Soc Echocardiogr, 2005; 18:991-7.

D’hooge J, Bijnens B, Jamal F, Pislaru C, Pislaru S, Thoen J, et al. High Frame Rate Myocardial In- tegrated Backscatter. Does this change our under- standing of this Acoustic Parameter? Eur J Echo- cardiogr, 2000; 1:32–41.

Todaro MC, Choudhuri I, Belohlavek M, Jahangir A, Carerj S, Oreto L et al. New echocardiographic techniques for evaluation of left atrial mechanics. Eur Heart J Cardiovasc Imaging, 2012; 13:973–84.

Choong CY, Herrmann HC, Weyman AE, Fifer MA. Preload dependence of Doppler-derived index- es of left ventricular diastolic function in humans. J Am Coll Cardiol, 1987; 10:800–808.

Manning WJ, Silverman DI, Katz SE, Riley MF, Doherty RM, Munson JT et al. Temporal depen- dence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to si- nus rhythm. Am J Cardiol, 1995; 75:624–626.

Thomas L, Thomas SP, Hoy M, Boyd A, Schiller NB, Ross DL. „Comparison of left atrial volume and function after linear ablation and after cardio- version for chronic atrial fibrillation. Am J Cardiol, 2004; 93:165–170.

Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL. Changes in regional left atrial func- tion with aging: evaluation by Doppler tissue imag- ing. Eur J Echocardiogr, 2003; 4:92–100.

Yuda S, Shimamoto K, Watanabe N. Clinical appli- cations of strain rate imaging for evaluation of left atrial function. Rinsho Byori, 2010; 58:799-808.

Motoki H, Dahiya A, Bhargava M, Wazni OM, Sal- iba WI, Marwick TH, et al. Assessment of left atrial mechanics in patients with atrial fibrillation: com- parison between two-dimensional speckle-based strain and velocity vector imaging. Am Soc Echo- cardiogr, 2012; 25:428-35.

Mewton N, Liu CY, Croisille P, Bluemke D, Lima JA. Assessment of Myocardial Fibrosis with Car- diac Magnetic Resonance. Am Coll Cardiol, 2011; 57(8): 891–903. doi: 10.1016/j.jacc.2010.11.013

Hachamovitch R, Rozanski A, Shaw LJ, Stone GW, Thomson LEJ et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial re- vascularization vs. medical therapy among patients undergoing stress–rest myocardial perfusion scin- tigraphy. Eur Heart J, 2011; 32:1012–1024.

van den Borne SW, Isobe S, Verjans JW, Petrov A, Lovhaug D et al. Molecular imaging of interstitial alterations in remodeling myocardium after myocar- dial infarction. J Am Coll Cardiol, 2008; 52:2017– 2028.

Sado DM, Flett AS, Moon JC. Novel imaging tech- niques for diffuse myocardial fibrosis. Future Car- diol, 2011; 7:643–650.



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