Myocardial Scar and Fibrosis: The Ultimate Mediator of Outcomes?

The cardiology community lacks a taxonomy to prioritize the origins of the complex myocardial pathology underlying heart failure. The key question, "Why does heart muscle fail?", remains unanswered. A large body of literature indicates that myocardial fibrosis represents a principal pathway mediating outcomes in heart failure. Cardiac amyloidosis illustrates how excess protein in the myocardial interstitium culminates in severe heart failure with a dismal prognosis. Robust methods now exist to quantify myocardial fibrosis. Investigators possess the tools to finally establish unequivocally that myocardial fibrosis represents one of the principal pathways mediating outcomes in heart failure that imparts vulnerability.