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The new 2023 ESC guidelines for the management of cardiomyopathies: a guiding path for cardiologist decisions
Maurizia Grasso1, Davide Bondavalli1, Viviana Vilardo1
1Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Insights
The 2023 European Society of Cardiology (ESC) guidelines offer a refined definition and classification for cardiomyopathies, improving diagnosis and management. These guidelines emphasize tailored care paths and integrate advanced fields like artificial intelligence for better patient outcomes.
Area of Science:
- Cardiology
- Genetics
- Biomedical Engineering
Background:
- Cardiomyopathies are myocardial disorders defined by structural and functional abnormalities, excluding other cardiac conditions.
- Existing classifications include hypertrophic, dilated, restrictive, and arrhythmogenic right ventricular cardiomyopathy, with a new category for left ventricular non-dilated cardiomyopathy.
- The 2023 European Society of Cardiology (ESC) guidelines update the diagnostic and management strategies for these complex heart muscle diseases.
Purpose of the Study:
- To present the updated ESC 2023 guidelines for diagnosing and managing cardiomyopathies.
- To highlight the classification of cardiomyopathies, including new categories and diagnostic criteria.
- To emphasize the integration of genetic evaluation, multidisciplinary approaches, and emerging technologies in cardiomyopathy care.
Main Methods:
- Review and synthesis of current evidence and expert consensus on cardiomyopathies.
- Development of a structured diagnostic and management framework based on updated classifications.
- Incorporation of recommendations for genetic testing, deep phenotyping, and multidisciplinary team involvement.
Main Results:
- Revised definition and morpho-functional classification of cardiomyopathies, including left ventricular non-dilated cardiomyopathy.
- Guidelines provide a framework for tailored diagnostic pathways and therapeutic indications, including targeted therapies.
- Emphasis on the role of genetics, deep phenotyping, and multidisciplinary evaluation for variant pathogenicity assessment.
Conclusions:
- The ESC 2023 guidelines offer a comprehensive approach to cardiomyopathy diagnosis and management, enhancing clinical cardiology practice.
- Integration of advanced disciplines like bioinformatics and artificial intelligence is crucial for future advancements in managing cardiomyopathies.
- Further research is needed to bridge the gap between scientific discovery and clinical application, particularly concerning the underutilized role of endomyocardial biopsy.
Abstract:
In the ESC 2023 guidelines, cardiomyopathies are conservatively defined as 'myocardial disorders in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease sufficient to cause the observed myocardial abnormality'. They are morpho-functionally classified as hypertrophic, dilated, restrictive, and arrhythmogenic right ventricular cardiomyopathy with the addition of the left ventricular non-dilated cardiomyopathy that describes intermediate phenotypes not fulfilling standard disease definitions despite the presence of myocardial disease on cardiac imaging or tissue analysis. The new ESC guidelines provide 'a guide to the diagnostic approach to cardiomyopathies, highlight general evaluation and management issues, and signpost the reader to the relevant evidence base for the recommendations'. The recommendations and suggestions included in the document provide the tools to build up pathways tailored to specific cardiomyopathy (phenotype and cause) and define therapeutic indications, including target therapies where possible. The impact is on clinical cardiology, where disease-specific care paths can be assisted by the guidelines, and on genetics, both clinics and testing, where deep phenotyping and participated multi-disciplinary evaluation provide a unique tool for validating the pathogenicity of variants. The role of endomyocardial biopsy remains underexploited and confined to particular forms of restrictive cardiomyopathy, myocarditis, and amyloidosis. New research and development will be needed to cover the gaps between science and clinics. Finally, the opening up to disciplines such as bioinformatics, bioengineering, mathematics, and physics will support clinical cardiologists in the best governance of the novel artificial intelligence-assisted resources.
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