Myocardial fibrosis is the shared final common pathological pathway in the development of chronic heart failure and it predicts poor prognosis.

Myocardial fibrosis results from the accumulation of collagen in the extracellular matrix, mediated by the complex interplay between pro-fibrotic cells, growth factors and inflammatory cytokines.

Various proposed anti-fibrotic drugs have been tested but their direct beneficial effects on human myocardial fibrosis are yet to be proven.

CMR techniques like native T1 mapping and extracellular volume have become the gold standard non-invasive imaging biomarkers of myocardial fibrosis.

Newer technologies in CMR are paving the way for large-scale, multicentre, randomised trials to determine the efficacy of newer anti-fibrotic therapies.