Myocardial Fibrosis in Hypertensive Heart Disease: Correlation with Serum Biomarkers and Perioperative Cardiovascular Outcome

Amir Asad  Shah; Muhammad Ismail  Khan; Ibtahaj Mohsin  Iqbal; Aleena  Ashraf; Ahmad  Rubeet

doi:10.54112/bcsrj.v6i6.1832

Authors

Amir Asad Shah Department of Pathology, Nishtar Medical University, Multan, Pakistan
Muhammad Ismail Khan High Security Prison Hospital, Mianwali, Pakistan
Ibtahaj Mohsin Iqbal Farooq Hospital, West Wood Colony Thokar Niaz Baig Lahore, Pakistan
Aleena Ashraf Bahria International Hospital Lahore Pakistan
Ahmad Rubeet Bahria International Hospital Lahore Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1832

Keywords:

Myocardial fibrosis, Hypertensive heart disease, NT proBNP, Galectin 3, hs Troponin-T, Perioperative outcomes, Cardiac MRI

Abstract

Myocardial fibrosis is a common but underdiagnosed complication of hypertensive heart disease (HHD). It contributes significantly to adverse perioperative cardiovascular outcomes. Cardiac MRI remains the gold standard for detection; however, accessibility is limited in low-resource settings, such as Pakistan. This study aimed to assess the correlation between serum biomarkers—NT-proBNP, high-sensitivity troponin T (hsTnT), and galectin 3—and MRI-detected myocardial fibrosis, and to evaluate their predictive value for perioperative complications. Methods: A prospective observational study was conducted at a tertiary care hospital in Multan between November 2022 and September 2024. A total of 84 hypertensive patients undergoing elective non-cardiac surgery were enrolled. Cardiac MRI was used to detect myocardial fibrosis. Serum levels of NT-proBNP, hs-TnT, and galectin-3 were measured preoperatively. Patients were monitored for perioperative cardiovascular events. Statistical analyses included t-tests, chi-square tests, and Pearson correlation. Results: MRI-confirmed myocardial fibrosis was present in 37 patients (44.0%). Patients with fibrosis had significantly higher mean levels of NT proBNP (583.2 ± 104.7 pg/mL vs 321.5 ± 89.3 pg/mL, p < 0.001), hs TnT (0.032 ± 0.010 ng/mL vs 0.019 ± 0.008 ng/mL, p < 0.001), and galectin 3 (19.7 ± 3.6 ng/mL vs 13.5 ± 2.8 ng/mL, p < 0.001). The incidence of perioperative cardiovascular complications was significantly higher in the fibrosis group (32.4% vs 9.6%, p = 0.005). Positive correlations were observed between biomarker levels and the extent of myocardial fibrosis. Conclusion: Serum biomarkers NT proBNP, hs TnT, and galectin three correlate strongly with MRI-detected myocardial fibrosis and are predictive of perioperative cardiovascular complications in hypertensive patients. These markers may serve as effective, low-cost alternatives for preoperative risk stratification in resource-limited settings.

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