Abstract
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.
Highlights
Myocardial architecture and cardiac function are closely linked [1,2,3,4,5,6,7]
Likewise, computed tomography describes the myocardial morphology by the use of a tensor, but in this case the tensor is calculated by variations in x-ray attenuation within the tissue, where the direction of least difference is deemed to represent the longitudinal course of the myocyte chains
This review points towards several controversies in the field of myocardial architecture
Summary
Myocardial architecture and cardiac function are closely linked [1,2,3,4,5,6,7]. the anatomy of the heart and the cellular construction of the myocardium has been the focus of research for centuries [8]. In an environment without cell membranes and other diffusion boundaries, the water molecules are likely to diffuse in all directions, the diffusion tensor assumes the shape To understand why this is the case, we need to dig a little deeper into the concepts of tissue diffusion. It has been suggested that the secondary eigenvector follows the surface of the flattened groupings of cardiomyocytes, often described as myocardial sheets [32], laminae [9], sheetlets [36], lamellae [37], lamellar units [7,38] or aggregated units of cardiomyocytes [30] This disagreement in nomenclature can be attributed to the current lack of a suitable three-dimensional anatomical description of these sub-structures. This review will discuss the variability and validity of current practices in the field and propose guidance to establish methodological consensus in the field
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