2134/24531 Matthew P.M. Graham-Brown Matthew P.M. Graham-Brown A.S. Patel A.S. Patel David Stensel David Stensel Daniel S. March Daniel S. March A.-M. Marsh A.-M. Marsh J. McAdam J. McAdam Gerry P. McCann Gerry P. McCann James O. Burton James O. Burton Imaging of myocardial fibrosis in patients with end-stage renal disease: Current limitations and future possibilities Loughborough University 2017 Cardiac MRI Echocardiogram Myocardial Fibrosis Cardiovascular disease End stage renal disease Hemodialysis Medical and Health Sciences not elsewhere classified 2017-03-24 13:32:28 Journal contribution https://repository.lboro.ac.uk/articles/journal_contribution/Imaging_of_myocardial_fibrosis_in_patients_with_end-stage_renal_disease_Current_limitations_and_future_possibilities/9624629 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.