Giordano Carla, Francone Marco, Cundari Giulia, Pisano Annalinda, d'Amati Giulia
Department of Radiology, Oncology and Pathology, Sapienza, University of Rome, Rome, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
Cardiovasc Pathol. 2022 Jan-Feb;56:107391. doi: 10.1016/j.carpath.2021.107391. Epub 2021 Oct 1.
Myocardial fibrosis is defined as an increased amount of collagen in the myocardium relative to cardiac myocytes. Two main morphologic patterns are recognized: 1) replacement fibrosis, which occurs in response to myocyte necrosis (myocardial scarring); and 2) interstitial fibrosis, which is usually a diffuse process and has been shown to be reversible and treatable. Replacement and interstitial fibrosis often coexist and are a constant feature of pathologic cardiac remodeling. In the last twenty years, there has been significant interest in developing objective non-invasive methods to identify and quantitatively assess myocardial fibrosis in vivo, both for diagnostic purposes and to improve stratification of patients. The present Review focuses on the morphologic patterns of myocardial fibrosis observed either at autopsy and heart transplant, or in vivo by non-invasive imaging techniques. Main aim is to provide clues for the differential diagnosis, with emphasis on entities whose diagnosis may be challenging. An update on the diagnostic and prognostic role of imaging, along with recent data on available biomarkers, is also proposed.
心肌纤维化的定义是相对于心肌细胞，心肌中胶原蛋白含量增加。主要识别出两种主要的形态学模式：1）替代性纤维化，它是对心肌细胞坏死（心肌瘢痕形成）的反应而发生；2）间质纤维化，这通常是一个弥漫性过程，并且已被证明是可逆的且可治疗的。替代性纤维化和间质纤维化常并存，是病理性心脏重塑的一个持续特征。在过去二十年中，人们对开发客观的非侵入性方法以在体内识别和定量评估心肌纤维化产生了浓厚兴趣，这既用于诊断目的，也用于改善患者分层。本综述重点关注在尸检和心脏移植时观察到的心肌纤维化的形态学模式，或通过非侵入性成像技术在体内观察到的形态学模式。主要目的是为鉴别诊断提供线索，重点关注诊断可能具有挑战性的实体。还提出了关于成像的诊断和预后作用的最新情况，以及有关可用生物标志物的最新数据。
