Advances in engineered 3D cardiac tissue for functional biosensing, disease modeling, and regenerative medicine

Three-dimensional (3D) engineered cardiac tissues are miniaturized in vitro cardiac models to recapitulate essential aspects of native heart physiology for applications in drug testing, disease modeling and regenerative therapy. Building on advances in microfabrication, biomaterials, bioelectronics and stem cell biology, these systems reproduce myocardial architecture, mechanical dynamics, electrical conductivity, and disease-specific phenotypes. Existing reviews treat biofabrication, biomaterials, functional biosensing, disease modeling, and cardiac regenerative therapy as separate topics, while few have framed these components within a unified micro- and nanoengineering framework that links tissue architecture, functional biosensing, and application-driven performance. This review addresses this gap by highlighting recent advances in biofabrication strategies for precise control over tissue architecture and cellular microenvironments and discusses the incorporation of microelectronic, optical, and mechanical biosensors for real-time, multiparametric monitoring of tissue contractility and electrophysiological activity. We further summarize representative applications in disease modeling such as cardiomyopathies, ischemic injury, and drug-induced cardiotoxicity, as well as the development of bioengineered cardiac constructs and patches as transplantable grafts to restore myocardial function. Finally, key challenges and future directions toward predictive, scalable, and translational cardiac microphysiological systems are discussed.