Ravassa Susana, González Arantxa, Bayés-Genís Antoni, Lupón Josep, Díez Javier
Program of Cardiovascular Diseases, CIMA Universidad de Navarra, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
CIBERCV, Carlos III Institute of Health, Madrid, Spain; Unitat d'Insuficiència Cardíaca, Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain.
Rev Esp Cardiol (Engl Ed). 2020 Mar;73(3):248-254. doi: 10.1016/j.rec.2019.09.010. Epub 2019 Nov 20.
Myocardial interstitial fibrosis is a constant pathological finding in structural heart diseases of various etiologies that evolve with heart failure. Although fibrosis facilitates heart failure progression, until now no therapeutic strategy has been developed that ensures its reversal. A possible explanation for this may lie in the vision of myocardial interstitial fibrosis as a homogeneous lesion instead of a heterogeneous lesion in which different phenotypes can be distinguished using appropriate criteria. In addition, the notion that the heterogeneity of myocardial interstitial fibrosis may be cardiac disease-specific must be also considered when approaching this entity. Therefore, we propose that myocardial interstitial fibrosis represents a true challenge for transitioning from usual care to biomarker-based personalized treatment and precision medicine in heart failure. As a proof-of-concept, in this review we discuss the phenotyping of myocardial interstitial fibrosis in patients with heart failure attributable to hypertensive heart disease based on its histomolecular alterations and provide evidence of the prognostic relevance of the resulting stratification. Furthermore, we discuss the available information on some circulating biomarkers and certain pharmacological agents useful for noninvasive identification and personalized treatment, respectively, of those phenotypes.
心肌间质纤维化是各种病因导致的结构性心脏病伴心力衰竭发展过程中持续存在的病理表现。尽管纤维化会促进心力衰竭的进展，但迄今为止尚未开发出能确保其逆转的治疗策略。对此的一种可能解释是，人们将心肌间质纤维化视为一种均质病变，而非可使用适当标准区分不同表型的异质病变。此外，在研究这一实体时，还必须考虑心肌间质纤维化的异质性可能具有心脏疾病特异性这一观点。因此，我们认为心肌间质纤维化是从心力衰竭的常规治疗向基于生物标志物的个性化治疗和精准医学转变的真正挑战。作为概念验证，在本综述中，我们基于组织分子改变讨论了高血压性心脏病所致心力衰竭患者心肌间质纤维化的表型分析，并提供了由此分层的预后相关性证据。此外，我们还讨论了一些循环生物标志物和某些药理药物的现有信息，它们分别可用于这些表型的无创识别和个性化治疗。
