Review process
All included hearts were assessed according to a rigorous 5-layer review process. Each specimen was independently examined for the study according to the review protocol without knowledge of previous assessments (S.M.K., layer 1). This analysis was compared with previous independent assessments made by in-house (A.C.) and visiting (R.H.A.) expert morphologists (layer 2), along with the observations obtained from the original hospital post-mortem report for each patient (layer 3). The assessor then re-evaluated each heart in light of any additional or conflicting information (layer 4), with any differences being rediscussed (with A.C., layer 5), and resolved by consensus.
This standardized review process was instituted to ensure consistency of the observations and measurements of each specimen. There is currently no reference standard for the assessment of heart specimens. Previous descriptions have been based solely on individual expert opinion. Such an approach introduces chances of error when dealing with morphological descriptions and quantitative measurements. Hence, we implemented our meticulous approach to ensure the validity of our findings.