The cardiac microstructure in health and disease

A new scanning technique now lets researchers see the heart’s microscopic muscle fibre structure in living patients for the first time. Until recently, studying the heart’s 3D microstructure—the alignment of muscle cells that determines how it contracts—required removing tissue after death. Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) changes that. It adapts the same method used to map brain wiring to track water movement along heart muscle fibres, revealing their organisation without a scalpel. This matters because many heart diseases, including cardiomyopathy and congenital heart defects, involve subtle disruptions to this microarchitecture that standard scans miss. Without seeing those changes, doctors cannot fully understand why some hearts fail or why treatments work for some patients but not others. This programme grant splits into two streams. One applies existing DT-CMR to patients with cardiomyopathy and congenital heart disease, testing whether the scans can spot microstructural damage early. The other improves the technique itself—boosting imaging speed and resolution so it becomes robust enough for routine clinical use. If successful, DT-CMR could become a diagnostic tool that catches structural deterioration before the heart loses pumping power, and a prognostic one that helps predict which patients will worsen. The work is applied, not fundamental: it aims to put a new imaging method directly into clinical decision-making.