Cardiac architecture: Gothic versus Romanesque. A cardiologist's view

The healthy left ventricle, with remarkable mechanical efficiency, has a gothic architecture, which results from the disposition of the myocardial fibers supported and maintained by a normal collagen matrix scaffold. This conclusion, arising from the analysis of roman and gothic buildings and from comparative biology of the left ventricles of different species, has been substantiated by the study of three-dimensional images obtained by MRI and analyzed with mathematic methods for measurements of the curvature and thickness of the ventricular walls. The assessment of left ventricular functional reserve based on the architecture has been very important in making therapeutic and surgical decisions in our patients and has important implications for the design of surgical strategies designed to try to improve ventricular function by restoring an architecture that allows more efficient ventricular mechanics. The structural approach and its combination with important advances in the knowledge of membrane channels, signaling pathways, cytokines, growth factors, neuroregulation, and targeted pharmacology, and with the advances in methods for reducing hemodynamic load and its cellular and structural consequences, is certain to bring about a dramatic change in the very serious and highly prevalent congestive failure associated with the Romanesque transformation of the diseased left ventricle.