Diagnostics and therapeutic interventions in myocardial interstitial disease, a previously neglected pathology

The emergence of cardiac fibrosis (the prototypal myocardial interstitial disease) as an important adverse predictor of risk in heart disease is not surprising given that it is largely responsible for cardiac stiffness, provides a substrate for rhythm disturbances and promotes tissue hypoxia and development of heart failure. Yet, this diagnosis remains difficult, treatment options remain limited and underlying mechanisms remain elusive. More recently, however, many notable advances in imaging techniques and biomarker discovery have been made to improve our understanding of remodelling changes that occur within the myocardial interstitium. Ground-breaking new evidence now suggests that fibrosis within the heart may not only be reversible but that it also may be amenable to pharmacological intervention. In this review, we discuss these recent advances and highlight the pressing urgency to better detect myocardial interstitial disease and to understand the underlying molecular biology that may enable discovery of more specific anti-remodelling therapies.