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ESC issues cardiomyopathy guidelines

The European Society of Cardiology has released its first major comprehensive international guidelines to address diagnosis and treatment of the broad causes of heart muscle dysfunction.

The document was released in conjunction with the European Society of Cardiology (ESC) Congress 2023 last month, reports Medscape.

“We considered cardiomyopathies across the life course from paediatric to adult,” said first author, Dr Elena Arbelo, co-ordinator of the Cardiac Genetic Diseases and Sudden Arrhythmic Death Unit, Hospital Clinic de Barcelona, Spain.

She is also one of two chairpersons of the ESC task force that brought the guidelines forward.

She said they are the first to “include all cardiomyopathy subtypes, and the first time that specific recommendations are made for cardiomyopathies other than hypertrophic cardiomyopathy” (HCM).

Cardiomyopathy phenotypes

Cardiomyopathy can present at any age, and can have multiple complex etiologies, including genetic predisposition, heart muscle injury from disease, or a mix of participating factors.

Dr Juan Kaski, co-chair of the tast force and professor of paediatric inherited cardiovascular medicine at the University College of London, said key innovations in the document include a diagnostic workup, “starting with a detailed phenotypic description, including the new phenotype of non-dilated left ventricular cardiomyopathy that then triggers a multiparametric, systematic evaluation”.

He said the guidelines have been organised around the patient pathway, and focus should be placed on recognising the presenting phenotype as a critical first step in discerning the underlying etiology and its treatments.

Genetic testing in children

Also included are specific recommendations about genetic testing of children, while the guidelines highlight the value of cardiovascular magnetic resonance (CMR) imaging in the “diagnosis, screening, monitoring, and prognostication” for patients of all ages.

Arbelo and Kaski said the task force did their best to make the guidelines user-friendly.

Recommendations are provided with an evidence-based classification: class I (recommended), class IIa (should be considered), class IIb (may be considered), and class III (not recommended).

Many symptoms related

The guidelines draw attention to the relationship of cardiomyopathy to common cardiovascular conditions, like heart failure, arrhythmia, and chest pain. Kaski said these are the types of problems commonly encountered by general cardiologists and primary care physicians.

In 2014, the ESC published guidelines specific to HCM. The new broader guidelines do not overlook this subtype, said Kaski, adding that there had several innovations in HCM since then, such as when to consider cardiac myosin inhibitors for symptomatic left ventricular outflow tract obstruction.

32 key messages

The guidelines include almost 90 pages of recommendations. The task force isolated 32 key messages from 13 sections, ranging from descriptions of how the patient pathway is defined to what types of physical activity should be considered for different forms of cardiomyopathy.

There is also a section devoted to important gaps in evidence and areas where is there is the most need for further studies.

“Most of the recommendations are new,” wrote the authors in the introduction.

Although they said they did not attempt to provide detailed recommendations for every cardiomyopathy phenotype, they have tried to cover general evaluation and management issues supported by relevant evidence.

 

Guidelines

 

Medscape article – ESC Issues First Comprehensive Cardiomyopathy Guidelines (Open access)

 

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Chemotherapy differences in long-term cardiomyopathy risk in children

 

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