Assessing myocardial architecture: the challenges and controversies

Research output: Contribution to journalReview articlepeer-review


Colleges, School and Institutes


In recent decades, investigators have strived to describe and quantify the orientation of the cardiac myocytes in an attempt to classify their arrangement in healthy and diseased hearts. There are, however, striking differences between the investigations from both a technical and methodological standpoint, thus limiting their comparability and impeding the drawing of appropriate physiological conclusions from the structural assessments. This review aims to elucidate these differences, and to propose guidance to establish methodological consensus in the field. The review outlines the theory behind myocyte orientation analysis, and importantly has identified pronounced differences in the definitions of otherwise widely accepted concepts of myocytic orientation. Based on the findings, recommendations are made for the future design of studies in the field of myocardial morphology. It is emphasised that projection of myocyte orientations, before quantification of their angulation, introduces considerable bias, and that angles should be assessed relative to the epicardial curvature. The transmural orientation of the cardiomyocytes should also not be neglected, as it is an important determinant of cardiac function. Finally, there is considerable disagreement in the literature as to how the orientation of myocardial aggregates should be assessed, but to do so in a mathematically meaningful way, the normal vector of the aggregate plane should be utilised.

Bibliographic note

Funding Information: Funding: Robert S. Stephenson was supported in part by the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 707663. Publisher Copyright: © 2020, MDPI AG. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.


Original languageEnglish
Article number47
Pages (from-to)1-17
Number of pages17
JournalJournal of Cardiovascular Development and Disease
Issue number4
Publication statusPublished - 29 Oct 2020


  • Diffusion tensor imaging, Heart, Methodology, Micro computed tomography, Myocardial aggregation, Myocyte orientation, Review