Fig. 5

Potential pathways in the progression from asymptomatic to symptomatic cardiovascular events from MESA CMR remodeling and fibrosis data. Aging leads to concentric remodeling (higher M/V ratio and maintained LV mass) without no focal scar (pathway 1) [5, 6, 69]. Typically hypertension progresses to concentric hypertrophy (higher M/V ratio and LV mass) without focal scar (pathway 2) [6, 31]. The pathway from concentric remodeling and hypertrophy to replacement fibrosis without MI (pathway 3) [31]. Individuals with concentric remodeling can develop vascular events with preserved LVEF (pathway 4) [5, 21]. Individuals with concentric remodeling with MI or severe coronary calcification can contribute to replacement fibrosis (pathway 5) [29]. Individuals with concentric hypertrophy can develop symptomatic vascular events either with replacement scar (pathway 6) [28] or without (pathway 7) [21, 22]. Black arrows depict MESA CMR results, and thicker dot arrow, a known pathway. MI = myocardial infarction. Abbreviations as in Fig. 1