title: Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities.
abstract: Cardiovascular disease in patients with end-stage renal disease (ESRD) is driven by a different set of processes than in the general population. These processes lead to pathological changes in cardiac structure and function that include the development of left ventricular hypertrophy and left ventricular dilatation and the development of myocardial fibrosis. Reduction in left ventricular hypertrophy has been the established goal of many interventional trials in patients with chronic kidney disease, but a recent systematic review has questioned whether reduction of left ventricular hypertrophy improves cardiovascular mortality as previously thought. The development of novel imaging biomarkers that link to cardiovascular outcomes and that are specific to the disease processes in ESRD is therefore required. Postmortem studies of patients with ESRD on hemodialysis have shown that the extent of myocardial fibrosis is strongly linked to cardiovascular death and accurate imaging of myocardial fibrosis would be an attractive target as an imaging biomarker. In this article we will discuss the current imaging methods available to measure myocardial fibrosis in patients with ESRD, the reliability of the techniques, specific challenges and important limitations in patients with ESRD, and how to further develop the techniques we have so they are sufficiently robust for use in future clinical trials.
authors.affiliation: John Walls Renal Unit, Leicester General Hospital, Leicester, UK; National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK; Department of Cardiovascular Science, NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK.
authors.forename: M P M
authors.identifier: 0000-0002-3744-1526
authors.initials: MP
authors.lastname: Graham-Brown
authors.affiliation: John Walls Renal Unit, Leicester General Hospital, Leicester, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
authors.forename: D J
authors.identifier: 0000-0001-9119-8590
authors.initials: DJ
authors.lastname: Stensel
authors.affiliation: John Walls Renal Unit, Leicester General Hospital, Leicester, UK.
authors.forename: D S
authors.identifier: 0000-0002-1468-6918
authors.initials: DS
authors.lastname: March
authors.affiliation: Department of Cardiovascular Science, NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK.
authors.forename: A-M
authors.initials: AM
authors.lastname: Marsh
authors.affiliation: Department of Cardiovascular Science, NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK.
authors.forename: J
authors.initials: J
authors.lastname: McAdam
authors.affiliation: Department of Cardiovascular Science, NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK.
authors.forename: G P
authors.initials: GP
authors.lastname: McCann
authors.affiliation: John Walls Renal Unit, Leicester General Hospital, Leicester, UK; Department of Cardiovascular Science, NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: J O
authors.initials: JO
authors.lastname: Burton
mesh_terms: D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D003933:Diagnosis; D005355:Fibrosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006435:Renal Dialysis