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Non-ischemic dilated cardiomyopathy and cardiac fibrosis

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Abstract

Cardiac fibrosis is associated with non-ischemic dilated cardiomyopathy, increasing its morbidity and mortality. Cardiac fibroblast is the keystone of fibrogenesis, being activated by numerous cellular and humoral factors. Macrophages, CD4+ and CD8+ T cells, mast cells, and endothelial cells stimulate fibrogenesis directly by activating cardiac fibroblasts and indirectly by synthetizing various profibrotic molecules. The synthesis of type 1 and type 3 collagen, fibronectin, and α-smooth muscle actin is rendered by various mechanisms like transforming growth factor-beta/small mothers against decapentaplegic pathway, renin angiotensin system, and estrogens, which in turn alter the extracellular matrix. Investigating the underlying mechanisms will allow the development of diagnostic and prognostic tools and discover novel specific therapies. Serum biomarkers aid in the diagnosis and tracking of cardiac fibrosis progression. The diagnostic gold standard is cardiac magnetic resonance with gadolinium administration that allows quantification of cardiac fibrosis either by late gadolinium enhancement assessment or by T1 mapping. Therefore, the goal is to stop and even reverse cardiac fibrosis by developing specific therapies that directly target fibrogenesis, in addition to the drugs used to treat heart failure. Cardiac resynchronization therapy had shown to revert myocardial remodeling and to reduce cardiac fibrosis. The purpose of this review is to provide an overview of currently available data.

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Authors and Affiliations

  1. Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 2-4 Clinicilor, 400006, Cluj-Napoca, Romania

    Bianca Olivia Cojan-Minzat, Alexandru Zlibut & Lucia Agoston-Coldea

  2. Department of Family Medicine, Cluj-Napoca, Romania

    Bianca Olivia Cojan-Minzat

  3. Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania

    Alexandru Zlibut

  4. 2nd Department of Internal Medicine, Emergency County Hospital, Cluj-Napoca, Romania

    Lucia Agoston-Coldea

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  1. Bianca Olivia Cojan-Minzat
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  2. Alexandru Zlibut
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B.C.M., A.Z., and L.A.C. researched data for the article. B.C.M. and A.Z. wrote the article. L.A.C. discussed the content of the article, and B.C.M., A.Z., and L.A.C. reviewed and edited before submission.

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Correspondence to Lucia Agoston-Coldea.

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Cojan-Minzat, B.O., Zlibut, A. & Agoston-Coldea, L. Non-ischemic dilated cardiomyopathy and cardiac fibrosis. Heart Fail Rev 26, 1081–1101 (2021). https://doi.org/10.1007/s10741-020-09940-0

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