Background: Myocardial fibrosis (MF) is a dynamic remodeling process characterized by excessive extracellular matrix (ECM) deposition, fibroblast activation, and dysregulated matrix turnover. Although initially reparative, persistent fibrotic remodeling promotes myocardial stiffening, electrical instability, and progressive cardiac dysfunction across diverse cardiovascular diseases. Circulating biomarkers reflecting collagen synthesis, degradation, proteolytic regulation, and inflammatory activation have emerged as potential tools for assessing fibrotic activity and risk stratification. Methods: This targeted narrative review was based on manually guided searches of PubMed and Scopus, supplemented by citation chaining and inclusion of landmark mechanistic and translational studies. Publications addressing myocardial extracellular matrix remodeling, circulating fibrosis-related biomarkers and imaging-derived fibrosis phenotypes were selected for qualitative synthesis. Results: Myocardial fibrosis reflects interconnected inflammatory, neurohormonal, oxidative, and extracellular matrix remodeling pathways. Among circulating biomarkers, C-terminal propeptide of procollagen type I (PICP) showed the most consistent association with myocardial collagen burden and adverse outcomes, whereas carboxy-terminal telopeptide of type I collagen (CITP), matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), galectin-3, osteopontin, soluble suppression of tumorigenicity 2 (sST2), and natriuretic peptides provided more context-dependent signals. Standalone interpretation remains limited by restricted cardiac specificity, renal dysfunction, systemic inflammation, assay heterogeneity, and lack of standardized thresholds. Integration with cardiac magnetic resonance (CMR)-derived late gadolinium enhancement (LGE), T1 mapping, and extracellular volume (ECV) may improve biological and structural phenotyping. Conclusions: Circulating biomarkers capture complementary dimensions of myocardial remodeling but cannot replace structural imaging. We propose an updated, hypothesis-generating biomarker–imaging framework integrating inflammatory activation, collagen turnover, matrix quality, hemodynamic stress, and structural imaging to support phenotypic stratification and future validation of antifibrotic strategies.

Introduction and aim of the study: The majority of bariatric procedures are performed in women of reproductive age, which has resulted in a growing number of pregnancies following bariatric surgery. The purpose of the study was to analyze whether obstetricians-gynecologists taking care of pregnancies after bariatric surgery possess sufficient knowledge about it. Materials and method: The study was conducted in the form of a multiple choice, anonymous survey, conducted among 123 certified specialists in obstetrics and gynecology and 37 residents training in obstetrics and gynecology. The questions were related to supplementation of vitamins and micronutrients, the appropriate time interval between bariatric surgery and pregnancy, dietary recommendations, diagnosing gestational diabetes mellitus, and risks for the fetus following bariatric surgery. Results: The majority of participants did not know the correct answers, with only one participant who answered correctly all the questions provided. There was a correlation between giving correct answers to the question about dietary recommendations and the question about risks existing during a pregnancy after bariatric surgery. Only 30% of participants knew how gestational diabetes mellitus should be diagnosed in pregnancies after bariatric surgery. Conclusions: To enhance safety for women and their children, it is of utmost importance to implement additional training and educational programs for obstetricians-gynecologists about optimum care for pregnancies after bariatric surgery.