Circulating Biomarkers of Myocardial Fibrosis
Myocardial fibrosis impairs cardiac function, in addition to facilitating arrhythmias and ischemia, and thus influences the evolution and outcome of cardiac diseases. Its assessment is therefore clinically relevant. Although tissue biopsy is the gold standard for the diagnosis of myocardial fibrosis, a number of circulating biomarkers have been proposed for the noninvasive assessment of this lesion. A review of the published clinical data available on these biomarkers shows that most of them lack proof that they actually reflect the myocardial accumulation of fibrous tissue. In this "call to action" article, we propose that this absence of proof may lead to misinterpretations when considering the incremental value provided by the biomarkers with respect to traditional diagnostic tools in the clinical handling of patients. We thus argue that strategies are needed to more strictly validate whether a given circulating biomarker actually reflects histologically proven myocardial fibrosis before it is applied clinically.
The search for biomarkers of structural myocardial remodeling with potential usefulness for the clinical handling of cardiac diseases has been a prolific field in the last few years. The investigation of circulating biomarkers for myocardial fibrosis, 1 key component of structural myocardial remodeling, has been accelerating at a remarkable pace. These investigations have deluged the clinical and research communities, however, with numerous candidates, few of which are likely to survive as useful clinical tools in terms of diagnosis, prognosis, and therapy monitoring. One possible explanation for this failure is that most of the proposed biomarkers lack proof that they actually reflect the quantitative and qualitative changes in collagen tissue characteristic of myocardial fibrosis. The present article focused on the necessity of accurately histologically validating each circulating molecule before it can be considered as a true biomarker of myocardial fibrosis in cardiac patients.
Abstract and Introduction
Abstract
Myocardial fibrosis impairs cardiac function, in addition to facilitating arrhythmias and ischemia, and thus influences the evolution and outcome of cardiac diseases. Its assessment is therefore clinically relevant. Although tissue biopsy is the gold standard for the diagnosis of myocardial fibrosis, a number of circulating biomarkers have been proposed for the noninvasive assessment of this lesion. A review of the published clinical data available on these biomarkers shows that most of them lack proof that they actually reflect the myocardial accumulation of fibrous tissue. In this "call to action" article, we propose that this absence of proof may lead to misinterpretations when considering the incremental value provided by the biomarkers with respect to traditional diagnostic tools in the clinical handling of patients. We thus argue that strategies are needed to more strictly validate whether a given circulating biomarker actually reflects histologically proven myocardial fibrosis before it is applied clinically.
Introduction
The search for biomarkers of structural myocardial remodeling with potential usefulness for the clinical handling of cardiac diseases has been a prolific field in the last few years. The investigation of circulating biomarkers for myocardial fibrosis, 1 key component of structural myocardial remodeling, has been accelerating at a remarkable pace. These investigations have deluged the clinical and research communities, however, with numerous candidates, few of which are likely to survive as useful clinical tools in terms of diagnosis, prognosis, and therapy monitoring. One possible explanation for this failure is that most of the proposed biomarkers lack proof that they actually reflect the quantitative and qualitative changes in collagen tissue characteristic of myocardial fibrosis. The present article focused on the necessity of accurately histologically validating each circulating molecule before it can be considered as a true biomarker of myocardial fibrosis in cardiac patients.
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