Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain.
CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
Nat Rev Cardiol. 2021 Jul;18(7):479-498. doi: 10.1038/s41569-020-00504-1. Epub 2021 Feb 10.
Diffuse myocardial fibrosis resulting from the excessive deposition of collagen fibres through the entire myocardium is encountered in a number of chronic cardiac diseases. This lesion results from alterations in the regulation of fibrillary collagen turnover by fibroblasts, facilitating the excessive deposition of type I and type III collagen fibres within the myocardial interstitium and around intramyocardial vessels. The available evidence suggests that, beyond the extent of fibrous deposits, collagen composition and the physicochemical properties of the fibres are also relevant in the detrimental effects of diffuse myocardial fibrosis on cardiac function and clinical outcomes in patients with heart failure. In this regard, findings from the past 20 years suggest that various clinicopathological phenotypes of diffuse myocardial fibrosis exist in patients with heart failure. In this Review, we summarize the current knowledge on the mechanisms and detrimental consequences of diffuse myocardial fibrosis in heart failure. Furthermore, we discuss the validity and usefulness of available imaging techniques and circulating biomarkers to assess the clinicopathological variation in this lesion and to track its clinical evolution. Finally, we highlight the currently available and potential future therapeutic strategies aimed at personalizing the prevention and reversal of diffuse myocardial fibrosis in patients with heart failure.
弥漫性心肌纤维化是由于心肌内胶原纤维过度沉积所致，在多种慢性心脏疾病中均可发生。这种病变是由于成纤维细胞对纤维状胶原转化的调节发生改变，导致Ⅰ型和Ⅲ型胶原纤维在心肌间质和心肌内血管周围过度沉积所致。现有证据表明，除了纤维沉积的程度外，胶原组成和纤维的物理化学特性在弥漫性心肌纤维化对心力衰竭患者心功能和临床结局的不良影响中也很重要。在这方面，过去 20 年的研究结果表明，心力衰竭患者存在各种弥漫性心肌纤维化的临床病理表型。在这篇综述中，我们总结了目前关于心力衰竭中弥漫性心肌纤维化的发生机制和不良后果的知识。此外，我们还讨论了现有成像技术和循环生物标志物评估该病变临床病理变异和跟踪其临床演变的有效性和实用性。最后，我们强调了目前可用于心力衰竭患者弥漫性心肌纤维化预防和逆转的治疗策略，并探讨了未来的潜在治疗策略。
