Otto Hannah¹, Peters Oskar², Voigt Laura³, Graf Leo⁴, Arnold Frieda⁵, Paul Moritz⁶, Kühn Nele⁷
ABSTRACT:
Cardiac fibrosis is a hallmark of pathological myocardial remodeling in heart failure (HF) and post-myocardial infarction (MI), contributing to diastolic dysfunction, arrhythmias, and disease progression. This review examines the role of fibrosis biomarkers in diagnosis, prognosis, and therapeutic targeting. We discuss collagen-derived markers such as PICP, CITP, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs), as well as myofibroblast activation markers including galectin-3 and periostin. Non-invasive imaging surrogates like extracellular volume (ECV) on cardiac magnetic resonance (CMR) are explored alongside emerging omics signatures, including microRNAs and proteomic panels. Clinical applications for risk stratification and novel antifibrotic therapies are highlighted, along with key challenges in biomarker validation, assay standardization, and integration into routine clinical practice.