Evaluation and management of recent onset cardiomyopathy in the current era of heart failure therapeutics. A clinical consensus statement of the Heart Failure Association of the ESC.

Recent-onset cardiomyopathy represents a clinically dynamic and potentially reversible clinical framework of non-ischemic cardiomyopathy, characterized by high variability in left ventricular (LV) function and arrhythmic risk. This clinical consensus statement provides a structured diagnostic and therapeutic approach based on two prognostic axes: the potential for left ventricular reverse remodeling (LVRR) and the risk of sudden cardiac death (SCD). We operationalize four trajectories in the LV evolution, ranging from recovered LV ejection fraction (LVEF) to persistently reduced LVEF. Multimodal stratification including echocardiography, cardiac magnetic resonance (CMR), genetic profiling, biomarkers, and early treatment response allows tailored decision-making on pharmacological and device-based therapies. We propose a unified management algorithm emphasizing early initiation of guideline-directed medical therapy, structured reassessment at 3 and 6 months, and individualized consideration of defibrillators, resynchronization therapy, arrhythmia ablation, transcatheter valve leaflet edge to edge repair, and advanced HF assessment. This document aims to support clinicians in risk stratification and timely management or referrals.

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Publication Details

Journal
ESC Heart Failure
Published
2026-04-26
DOI
https://doi.org/10.1093/eschf/xvag115
Primary Topic
Cardiomyopathy and Myosin Studies
Type
article
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article

Evaluation and management of recent onset cardiomyopathy in the current era of heart failure therapeutics. A clinical consensus statement of the Heart Failure Association of the ESC.

Amr Abdin, Gianluigi Savarese, Dimitrios T. Farmakis, Arsen Ristić et al.
ESC Heart Failure
Cardiomyopathy and Myosin Studies
article

Evaluation and management of recent onset cardiomyopathy in the current era of heart failure therapeutics. A clinical consensus statement of the Heart Failure Association of the ESC.

Amr Abdin, Gianluigi Savarese, Dimitrios T. Farmakis, Arsen Ristić, Hadi Skouri, Wilfried Müllens, Tuvia Ben Gal, Petar Seferovic, C Bucciarelli Ducci, S Heymans, Marco Metra, Sanjay K Prasad, Ovidiu Chioncel, Karin Klingel, Giuseppe Rosano, Randall C Starling, Piotr Ponikowiski, Peter Van der Meer, Carsten Tschöpe, Antoni Bayes-Genis
article en

Abstract

Recent-onset cardiomyopathy represents a clinically dynamic and potentially reversible clinical framework of non-ischemic cardiomyopathy, characterized by high variability in left ventricular (LV) function and arrhythmic risk. This clinical consensus statement provides a structured diagnostic and therapeutic approach based on two prognostic axes: the potential for left ventricular reverse remodeling (LVRR) and the risk of sudden cardiac death (SCD). We operationalize four trajectories in the LV evolution, ranging from recovered LV ejection fraction (LVEF) to persistently reduced LVEF. Multimodal stratification including echocardiography, cardiac magnetic resonance (CMR), genetic profiling, biomarkers, and early treatment response allows tailored decision-making on pharmacological and device-based therapies. We propose a unified management algorithm emphasizing early initiation of guideline-directed medical therapy, structured reassessment at 3 and 6 months, and individualized consideration of defibrillators, resynchronization therapy, arrhythmia ablation, transcatheter valve leaflet edge to edge repair, and advanced HF assessment. This document aims to support clinicians in risk stratification and timely management or referrals.

ESC Heart Failure
Cleveland Clinic (US), University Medical Center Groningen (NL), Serbian Academy of Sciences and Arts (RS), Vita-Salute San Raffaele University (IT), Carol Davila University of Medicine and Pharmacy (RO), Tel Aviv University (IL), University of Balamand (LB), University of Groningen (NL), King's College London (GB), Università degli studi di Cassino e del Lazio Meridionale (IT), National and Kapodistrian University of Athens (GR), Rabin Medical Center (IL), Harefield Hospital (GB), Karolinska Institutet (SE), San Raffaele University of Rome (IT), Maastricht University (NL), Wroclaw Medical University (PL), Humboldt-Universität zu Berlin (DE), University of Belgrade (RS), Sheikh Shakhbout Medical City (AE), Universitätsklinikum des Saarlandes (DE), Stockholm South General Hospital (SE), Deutsches Herzzentrum der Charité (DE), St. Thomas Hospital (CA), German Centre for Cardiovascular Research (DE), University Clinical Centre (PL), University of Arts in Belgrade (RS), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Mylan (Switzerland) (CH), ERN GUARD-Heart (NL), Ziekenhuis Oost-Limburg (BE), Hospital Universitari Germans Trias i Pujol (ES), Freie Universität Berlin (DE), Charité - Universitätsmedizin Berlin (DE), University of Tübingen (DE), Hasselt University (BE), KU Leuven (BE)
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