The Implications and Assessment of Myocardial Fibrosis in Older Cardiovascular Patients

Myocardial fibrosis (MF) may play a role in homeostenosis—the decreasing ability of the aging heart to tolerate stressors and cardiac insults—since MF distorts myocardial architecture, impairs mechanical, electrical, and vasomotor function, and culminates in vulnerability to adverse outcomes. While MF is prevalent in many cardiac disorders found in older people, most MF is not attributable to age. MF is a dynamic process whereby synthesis predominates over degradation. Importantly, MF is reversible which likely leads to regression of mechanical and vasomotor abnormalities and survival benefit. MF may be a therapeutic target. Cardiac magnetic resonance using T1 mapping and extracellular volume measures offers a novel and non-invasive capability to quantify the entire spectrum MF and also detect cardiac amyloidosis. MF may represent an important phenotype to identify for diagnostic and prognostic decision making or even therapeutic decision-making even though its causes and optimal treatment are not fully understood.