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BioMed Research International
Volume 2017 (2017), Article ID 5453606, 14 pages
https://doi.org/10.1155/2017/5453606
Review Article

Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities

1John Walls Renal Unit, Leicester General Hospital, Leicester, UK
2National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
3Department of Cardiovascular Science, NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK
4Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK

Correspondence should be addressed to M. P. M. Graham-Brown

Received 18 October 2016; Revised 30 January 2017; Accepted 12 February 2017; Published 2 March 2017

Academic Editor: Marco Francone

Copyright © 2017 M. P. M. Graham-Brown et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.