ArticleFrontiers in cardiovascular medicine2026
Myocardial fibrosis and tissue alterations predict cardiovascular outcomes in chronic kidney disease-a prospective virtual twin study design using large-scale population database.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Myocardial fibrosis is a key feature of chronic kidney disease (CKD) and may contribute to its disproportionate cardiovascular (CV) burden. Cardiovascular magnetic resonance (CMR) T1-mapping quantifies diffuse fibrosis non-invasively, but its prognostic value in CKD remains uncertain. Aims: To investigate associations between native myocardial T1, mortality and incident CV outcomes, in CKD using a virtual twin-matching framework within the UK Biobank imaging cohort. Methods: We conducted a 1:1 virtual twin-matched case-cohort study of CKD cases and phenotypically matched non-CKD controls based on demographics, comorbidities, socioeconomic status, and cardiovascular risk factors. Paired analyses compared myocardial T1 between groups, and stratified Cox models estimated the effect of a 1-SD T1 increase on incident outcomes over a median follow-up of 4.9 years. Results: Among 193 matched pairs (median age 68 years; 57.5% women), CKD participants had trend-level higher myocardial T1 values than controls ( Conclusions: Elevated native myocardial T1 was independently associated with CV death, heart failure, and atrial fibrillation in CKD. Virtual twin-matching framework improved comparability and internal validity in matched pairs supporting the precision-matched cohort designs for mechanistic inference and risk stratification in multimorbid populations.
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